An Early-Stage Decision-Analytic Health Economic Model of Above Cuff Vocalization: What Do We Know and What Do We Need to Resolve?.

Mills, CS.; Michou, E.; Bellamy, MC.; Siddle, HJ.; Brennan, CA.; Bojke, C.

An Early-Stage Decision-Analytic Health Economic Model of Above Cuff Vocalization: What Do We Know and What Do We Need to Resolve?.

All Authors

Mills, CS.

Michou, E.

Bellamy, MC.

Siddle, HJ.

Brennan, CA.

Bojke, C.

LTHT Author

Mills, Claire
Siddle, Heidi

LTHT Department

Adult Therapies
Speech & Language Therapy
Podiatry

Non Medic

Speech & Language Therapist
Consultant Podiatrist

Publication Date

2025

Item Type

Journal Article

Abstract

OBJECTIVES: Above cuff vocalization (ACV) is used in patients with a tracheostomy in the ICU despite limited evidence. This early-stage decision-analytic model (DAM) for ACV evaluates the expected cost-effectiveness exploring the impact of uncertainty to identify key drivers of cost and effect and critical further research priorities. PERSPECTIVE: U.K. National Health Service. SETTING: Hypothetical cohort of general ICU patients with a tracheostomy, 63 years old, 64% male. METHODS: A de novo decision-analytic health economic model comparing ACV to usual care (UC). Model parameters were acquired from the literature review and expert opinion. One-way sensitivity analyses were conducted to identify key drivers of cost-effectiveness. RESULTS: The daily cost of ACV in the ICU ranged from 75 to 89 (USD 101-120), with most of this cost attributable to staff resources for delivery. The base-case scenario revealed ACV is potentially cost-effective, dominating UC with cost savings of 9,488 (USD 12,808) and 0.395 Quality-Adjusted Life Years gained. Most sensitivity analyses revealed that ACV dominated UC, costing less and being more effective. When ACV had a negative impact on ICU and ward length of stay (LoS), or had no effect on the speed of weaning, it was not cost-effective. The primary driver of cost was whether ACV affected the speed of weaning and ICU LoS. The two primary drivers of effect were: i) whether ACV impacted which end state a patient transitioned to and ii) whether ACV had a sustained positive impact on quality of life. CONCLUSIONS: Despite the substantial input required from speech-language pathologists-a typically scarce resource in ICU settings-ACV demonstrates strong potential for cost-effectiveness. There is no reason for decision-makers to de-adopt ACV, and delaying adoption may result in loss of opportunity costs. Improved reporting of mortality and utility data in critical care research would increase the reliability of early-stage DAMs.