Summary of economic evaluation framework
| Question | Is the use of probiotics as compared with standard care without probiotics cost-effective for the prevention of VAP and other clinically important outcomes in critically ill medical-surgical patients in PROSPECT? |
| Perspective | Public payer (in-hospital costs) |
| Setting | Ventilated ICU patients (44 centres, 3 countries: 41 Canada, 2 USA, 1 Saudi Arabia) |
| Comparators | Probiotics (Lactobacillus rhamnosus GG) with usual care vs usual care without probiotics |
| Time horizon | From ICU participant admission to hospital discharge/death (non-fixed time span) |
| Discount rate | No discounting (no long-term follow-up over 1 year) |
| Clinical outcomes | VAP, CDAD, AAD, length of stay and mortality (ICU and hospital) |
| Costs | Direct medical costs associated with treatment and complications (ICU and ward costs, personnel, medications, laboratory tests, diagnostic testing and procedures/surgeries) |
| Evaluation | Primary outcome: incremental cost-efficacy ratios (ICERs) per in-hospital VAP event avoided Secondary outcomes: ICERs for other clinically important outcomes:
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| Currency (price date) | US dollars (2019) |
| Uncertainty | Non-parametric bootstrapping to produce confidence intervals Cost sampling from various hospitals (stratified by location) Sensitivity analyses to deal with structural and methodological uncertainty |
AAD, antibiotic associated diarrhoea; CDAD, Clostriodiodes difficile–associated diarrhoea; ICER, incremental cost-efficacy/effectiveness ratio; ICU, intensive care unit; PROSPECT, Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial; VAP, ventilator-associated pneumonia.