Evidence map›Paper›PMID 36289153›Full record

Trial reportCanadian journal of anaesthesia = Journal canadien d'anesthesie2022

Health economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): a cost-effectiveness analysis.

Vincent I Lau, Feng Xie, Robert A Fowler, Bram Rochwerg, Jennie Johnstone, François Lauzier, John C Marshall, John Basmaji, William Henderson, Kosar Khwaja and 8 more

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01782755 (Probiotics), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01782755 phase2completednot on this map

Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT): A Feasibility Clinical Trial

TypeinterventionalSponsorMcMaster UniversityRan2013 to 2015Enrolled150ConditionsVentilator Associated Pneumonia (VAP), Other Infections, Antibiotic-Associated Diarrhea, C-DifficileArmsL. rhamnosus GG - Probiotic, Placebo - Microcrystalline Cellulose
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Review
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 13 institutions in 4 countries.

Vincent I LauDepartment of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada. vince.lau@ualberta.ca.ORCID http://orcid.org/0000-0002-9939-7348
Feng XieDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Robert A FowlerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Bram RochwergDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Jennie JohnstoneDepartment of Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.
François LauzierDepartments of Medicine, Anesthesiology & Critical Care, Université Laval, Quebec, QC, Canada.
John C MarshallInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
John BasmajiDivision of Critical Care Medicine, Department of Medicine, Western University, London, ON, Canada.
William HendersonDivision of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada.
Kosar KhwajaDepartments of Surgery and Critical Care Medicine, McGill University, Montreal, QC, Canada.
Osama LoubaniDepartment of Critical Care, Dalhousie University, Halifax, NS, Canada.
Daniel J NivenDepartment of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Ryan ZarychanskiSections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada.
Yaseen M ArabiIntensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia.
Rodrigo Cartin-CebaDivision of Pulmonary Medicine and Critical Care, Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA.
Lehana ThabaneDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Diane Heels-AnsdellDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Deborah J CookDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Impact · CAUniversity of Toronto · CAAlberta Health Services · CADalhousie University · CAKing Saud bin Abdulaziz University for Health Sciences · SAMayo Clinic Hospital · USMcGill University · CAThe Centre for Health (New Zealand) · NZUniversité Laval · CAUniversity of British Columbia · CAUniversity of Calgary · CAUniversity of Manitoba · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWe sought to compare the cost-effectiveness of probiotics and usual care with usual care without probiotics in mechanically ventilated, intensive care unit patients alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT).

methodsWe conducted a health economic evaluation alongside the PROSPECT randomized control trial (October 2013-March 2019). We adopted a public healthcare payer's perspective. Forty-four intensive care units in three countries (Canada/USA/Saudi Arabia) with adult critically ill, mechanically ventilated patients (N = 2,650) were included. Interventions were probiotics (Lactobacillus rhamnosus GG) vs placebo administered enterally twice daily. We collected healthcare resource use and estimated unit costs in 2019 United States dollars (USD) over a time horizon from randomization to hospital discharge/death. We calculated incremental cost-effectiveness ratios (ICERs) comparing probiotics vs usual care. The primary outcome was incremental cost per ventilator-associated pneumonia (VAP) event averted; secondary outcomes were costs per Clostridioides difficile-associated diarrhea (CDAD), antibiotic-associated diarrhea (AAD), and mortality averted. Uncertainty was investigated using nonparametric bootstrapping and sensitivity analyses.

resultsMean (standard deviation [SD]) cost per patient was USD 66,914 (91,098) for patients randomized to probiotics, with a median [interquartile range (IQR)] of USD 42,947 [22,239 to 76,205]. By comparison, for those not receiving probiotics, mean (SD) cost per patient was USD 62,701 (78,676) (median [IQR], USD 41,102 [23,170 to 75,140]; incremental cost, USD 4,213; 95% confidence interval [CI], -2,269 to 10,708). Incremental cost-effectiveness ratios for VAP or AAD events averted, probiotics were dominated by usual care (more expensive, with similar effectiveness). The ICERs were USD 1,473,400 per CDAD event averted (95% CI, undefined) and USD 396,764 per death averted (95% CI, undefined). Cost-effectiveness acceptability curves reveal that probiotics were not cost-effective across wide ranges of plausible willingness-to-pay thresholds. Sensitivity analyses did not change the conclusions.

conclusionsProbiotics for VAP prevention among critically ill patients were not cost-effective. Study registration data www. CLINICALTRIALS: gov (NCT01782755); registered 4 February 2013.

Indexed as

Pneumonia, Ventilator-AssociatedProbioticsAdultCost-Benefit AnalysisCritical IllnessDiarrheaHumanscost-effectivenesscritical careeconomicsinfectionprobioticsPROSPECTventilator-associated pneumonia

Identifiers

PMID36289153
OpenAlexW4307348291

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.