Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation

Background: Prior studies have compared outcomes and costs between bedside tracheostomy (BT) and operating room tracheostomy (ORT). However, studies have not performed a formal cost-effectiveness analysis of BT versus ORT. Methods: We present a cost-effectiveness study using Markov microsimulation for BT versus ORT. We abstracted model parameters from currently available literature and performed deterministic and probabilistic sensitivity analyses. Results: BT was more cost-effective than ORT at a $100,000/quality-adjusted life year willingness to pay (WTP) threshold. Our model was sensitive to postoperative pneumonia rates and pneumonia treatment costs. BT was more cost-effective in most iterations within a range of WTP thresholds from $0 to $200,000. Conclusions: BT is more cost-effective than ORT for critically ill patients at low-average risk for postoperative pneumonia. Our findings support considering bedside tracheostomy before performing the same procedure in the operating room, regardless of whether the approach is percutaneous or open.