ArticleCritical care explorations2025
An Early-Stage Decision-Analytic Health Economic Model of Above Cuff Vocalization: What Do We Know and What Do We Need to Resolve?
Article in Critical care explorations, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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Who cites it
1 citing paper in PubMed.
- Above Cuff Vocalization for Patients with Tracheostomy: An Evidence Informed, Interprofessional Practice Guidance (2026).Tracheostomy (Warrenville, Ill.) · 2026Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesAbove 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.
settingHypothetical cohort of general ICU patients with a tracheostomy, 63 years old, 64% male.
methodsA 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.
resultsThe 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.
conclusionsDespite 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.
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