Pmd21 Cost Benefit Analysis for Centrifugal Versus Membrane-Based Therapeutic Plasma Exchange

Abstract

Objectives: Recent epidemiological and cost analyses show statistically significant associations between hypotension during ICU stay with death, acute kidney injury (AKI) and hospital costs at MAP levels below 65mmHg. This analysis estimates the associated cost savings per ICU patient that accrue to US hospitals as a result of improved hypotension control between MAP of 65 mmHg and 85 mmHg. Methods: In our economic analysis we estimated patient-level costs associated with hypotension reduction in septic ICU patients from the hospital perspective. The reduction in the probabilities of AKI and death were sourced from a prior EMR (Electronic Medical Records) analysis in which hypotension exposure was defined by timeweighted average mean arterial pressure (TWA-MAP). Our analysis focused on TWA-MAP levels between 65-85 mmHg. Cost savings for each of the separate outcomes in sepsis was estimated from the current published literature. All dollars were adjusted to reflect 2018 costs. Scenario analyses and Monte Carlo simulations were performed to test the robustness of the model. We also developed a second model as a robustness check. Results: For our main model, we ran two simulations (10,000 trials each). These models compared expected cost difference in A) 65 vs. 75 TWA-MPA mmHg and B) 75 vs. 85 TWA-MAP mmHg hypothetical patients. Cost savings were A