Economic Evaluation of a Patient-Directed Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support

Objectives: Music intervention has been shown to reduce anxiety and sedative exposure among mechanically ventilated patients. Whether music intervention reduces ICU costs is not known. The aim of this study was to examine ICU costs for patients receiving a patient-directed music intervention compared with patients who received usual ICU care. Design: A cost-effectiveness analysis from the hospital perspective was conducted to determine if patient-directed music intervention was cost-effective in improving patient-reported anxiety. Cost savings were also evaluated. One-way and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness. Setting: Midwestern ICUs. Patients: Adult ICU patients from a parent clinical trial receiving mechanical ventilatory support. Interventions: Patients receiving the experimental patient-directed music intervention received a MP3 player, noise-canceling headphones, and music tailored to individual preferences by a music therapist. Measurements and Main Results: The base case cost-effectiveness analysis estimated patient-directed music intervention reduced anxiety by 19 points on the Visual Analogue Scale-Anxiety with a reduction in cost of $2,322/patient compared with usual ICU care, resulting in patient-directed music dominance. The probabilistic cost-effectiveness analysis found that average patient-directed music intervention costs were $2,155 less than usual ICU care and projected that cost saving is achieved in 70% of 1,000 iterations. Based on break-even analyses, cost saving is achieved if the per-patient cost of patient-directed music intervention remains below $2,651, a value eight times the base case of $329. Conclusions: Patient-directed music intervention is cost-effective for reducing anxiety in mechanically ventilated ICU patients. This work was performed at Mayo Clinic, Rochester, MN; The Ohio State University, Columbus, OH; Augsburg College, Minneapolis, MN; University of Minnesota, Minneapolis, MN. Clinical Trial Registration: ClinicalTrials.gov NCT00440700. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Supported, in part, by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01 NR009295 (Dr. Chlan, principal investigator). Dr. Chlan's institution received funding from National Institute of Nursing Research, National Institutes of Health (NIH), and she received funding from Yale University, Springer Publishing, and the American Association of Critical Care Nurses. Drs. Chlan, Heiderscheit, and Skaar received support for article research from the NIH. Dr. Neidecker disclosed that she does not have any potential conflicts of interest. For information regarding this article, E-mail: chlan.linda@mayo.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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