Evaluating the Cost-Effectiveness of the ABCDE Bundle: Impact of Bundle Adherence on Inpatient and 1-Year Mortality and Costs of Care*

Abstract

Objectives: Growing evidence supports the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle processes as improving a number of short- and long-term clinical outcomes for patients requiring ICU care. To assess the cost-effectiveness of this intervention, we determined the impact of ABCDE bundle adherence on inpatient and 1-year mortality, quality-adjusted life-years, length of stay, and costs of care. Design: We conducted a 2-year, prospective, cost-effectiveness study in 12 adult ICUs in six hospitals belonging to a large, integrated healthcare delivery system. Setting: Hospitals included a large, urban tertiary referral center and five community hospitals. ICUs included medical/surgical, trauma, neurologic, and cardiac care units. Patients: The study included 2,953 patients, 18 years old or older, with an ICU stay greater than 24 hours, who were on a ventilator for more than 24 hours and less than 14 days. Intervention: ABCDE bundle. Measurements and Main Results: We used propensity score-adjusted regression models to determine the impact of high bundle adherence on inpatient mortality, discharge status, length of stay, and costs. A Markov model was used to estimate the potential effect of improved bundle adherence on healthcare costs and quality-adjusted life-years in the year following ICU admission. We found that patients with high ABCDE bundle adherence (≥ 60%) had significantly decreased odds of inpatient mortality (odds ratio 0.28) and significantly higher costs ($3,920) of inpatient care. The incremental cost-effectiveness ratio of high bundle adherence was $15,077 (95% CI, $13,675–$16,479) per life saved and $1,057 per life-year saved. High bundle adherence was associated with a 0.12 increase in quality-adjusted life-years, a $4,949 increase in 1-year care costs, and an incremental cost-effectiveness ratio of $42,120 per quality-adjusted life-year. Conclusions: The ABCDE bundle appears to be a cost-effective means to reduce in-hospital and 1-year mortality for patients with an ICU stay.

Impact of ABCDE Bundle Implementation in the Intensive Care Unit on Specific Patient Costs

“…Cost centers that accounted for the largest proportion of hospital costs in both ICUs (Figure 1A, B and Online Appendix Table 1) were, in descending order: medications (32% in the comparison ICU and 29% in the intervention hospital), respiratory therapy (20% and 21%), blood bank (15% and 18%), laboratory (12% and 11%), and diagnostic radiology (7% and 6%). Resource utilization during the hospital stay was lower in the intervention ICU: (51 [33-81] vs 65.5 [36-92] laboratory tests per patient, P < 0.001; 8 [5][6][7][8][9][10][11][12] vs 13 [8][9][10][11][12][13][14][15][16][17][18][19][20][21] diagnostic radiology tests per patient, P < 0.001; Figure 2A and B).…”

“…12 Collinsworth et al showed it to be a cost-effective intervention to decrease mortality in critically ill patients. 13 Despite this evidence of benefit, however, only 45% of US ICUs have early mobilization programs. 14,15…”

“…12 Collinsworth et al showed it to be a cost-effective intervention to decrease mortality in critically ill patients. 13 Despite this evidence of benefit, however, only 45% of US ICUs have early mobilization programs. 14,15 Financial support and staffing are 2 of the main barriers to adoption and implementation of the ABCDE bundle.…”

Impact of the COVID-19 pandemic on the diagnosis and treatment of onco-hematologic patients: a discussion paper

“…They continued with some of the symptoms that defined their acute ventilation and ICU stay, as well as impacting other outcomes such as mortality. The nutritional approach to patients, identifying nutritional needs specific to each situation improves the functional capacity of patients, reducing sequelae and reducing days of hospital stay [122][123][124][125].…”

Management of complex pelvic-perineal soft tissue infection in open pelvic fractures: Comparison between conventional and modified instillation negative-pressure wound therapy

“…The predisposing factor related to wound healing was diabetes mellitus in four patients (three patients (38%) in the m-iNPWT group and one patient (13%) in the cNPWT group). All patients had systolic blood pressure < 90 mmHg in the emergency department, and the median ISS was 42 (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43).…”