The Economic Impact of a PEEP-based Lung Recruitment Clinical Trial Programme in Patients with Acute Respiratory Distress Syndrome

Abstract Background: Acute respiratory distress syndrome (ARDS) is one of the most challenging clinical conditions of the critical care medicine. Previous studies estimate the economic impact and the public return of the clinical trials on public health. Methods: The ART was conducted through a multicenter randomized trial at 120 intensive care units (ICUs) from 9 countries from November , 2011, through April, 2017, enrolling adults with moderate-to-severe ARDS, which investigated whether lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients compared with a conventional low-PEEP strategy. This paper identifies the economic impact of the clinical trial from the value of lives saved if the trial findings were implemented in the eligible patient populations for one year, and then computes the public return by subtracting the relevant clinical trial costs from the gross benefit. The economic impact was computed by subtracting the ART costs from its gross benefit. Results: The net benefit of the ART is approximately 152 millions of dollars if the ART findings is implemented in 50% of the eligible patients in Brazil, under the baseline assumptions. Moreover, for every dollar spent in the clinical trial, a return of 114 dollars was achieved in Brazil alone. If the ART’s trial findings were implemented in all eligible patients, then a return of the trial would be 229.5 dollars for every one dollar invested, and net benefit would be around 304 millions of dollars. Conclusions: These findings highlight the substantial economic benefit of clinical trials on ARDS treatments for the society. It also points out that the public return of clinical trials can be potentialized when the new trials’ findings are fully implemented on eligible patients. Efforts should be made to integrate clinical trials findings with the frontline health care delivery.