Title: 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 (Table 1). 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. TABLE 1. Incremental Cost-Effectiveness Ratio of Patient-Directed Music Versus Usual ICU Care Cost-Effectiveness Components PDM UC Incremental Value Costs Patient-directed music intervention, $ 329 Not applicable ICU cost, $ 127,343 129,803 Physician cost, $ 3,728 3,898 Sedative medication savings during PDM intervention period, a $ -22 Total cost, $ 131,379 133,701 - 2,322 Effectiveness Anxiety score (100-mm Visual Analogue Scale for Anxiety) 33 52 - 19 Study Outcomes Incremental cost-effective ratio, b incremental cost per unit change in anxiety score PDM dominates UC in 70% of probabilistic sensitivity analysis iterations PDM = patient-directed music, UC = usual ICU care. a Sedative medications are included in ICU costs, and therefore, no adjustment in sedative medication costs were made for UC. b Incremental cost-effective ratio assumes a $0 willingness-to-pay to reduce the Visual Analogue Scale for Anxiety score by one unit. Reference: Chlan LL, Heiderscheit A, Skaar DJ, Neidecker M.

1. Title: 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 (Table 1). 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.
TABLE 1. Incremental Cost-Effectiveness Ratio of Patient-Directed Music Versus Usual ICU
Care
Cost-Effectiveness Components
PDM
UC
Incremental Value
Costs

2. Patient-directed music intervention, $
329
Not applicable
ICU cost, $
127,343
129,803
Physician cost, $
3,728
3,898
Sedative medication savings during PDM intervention period, a
$
-22
Total cost, $
131,379
133,701
- 2,322
Effectiveness
Anxiety score (100-mm Visual Analogue Scale for Anxiety)
33
52
- 19
Study Outcomes
Incremental cost-effective ratio, b
incremental cost per unit change in anxiety score
PDM dominates UC in 70% of probabilistic sensitivity analysis iterations

3. PDM = patient-directed music, UC = usual ICU care.
a
Sedative medications are included in ICU costs, and therefore, no adjustment in sedative
medication costs were made for UC.
b
Incremental cost-effective ratio assumes a $0 willingness-to-pay to reduce the Visual Analogue
Scale for Anxiety score by one unit.
Reference:
Chlan LL, Heiderscheit A, Skaar DJ, Neidecker MV. Economic Evaluation of a Patient-Directed
Music Intervention for ICU Patients Receiving Mechanical Ventilatory Support. Crit Care Med .
2018;46(9):1430-1435. doi:10.1097/CCM.0000000000003199
Questions :
Please critique the abstract by answering the following questions. Please use complete sentences.
Provide rationale or give examples to support your answers.
Was the title appropriate? Why or why not?
Were you able to determine the perspective? If so, what was it?
Was the type of study stated? What type of economic evaluation was it?
What was the clinical outcome (i.e., effectiveness measure)? Was it relevant or important?
Were sensitivity analyses performed? If so, can you tell for which variables?
Cost-Effectiveness Components PDM UC Incremental Value
Costs
Patient-directed music intervention, $ 329 Not applicable
ICU cost, $ 127,343 129,803
Physician cost, $ 3,728 3,898
Sedative medication savings during PDM
intervention period, a
$
-22
Total cost, $ 131,379 133,701 - 2,322
Effectiveness
Anxiety score (100-mm Visual Analogue Scale
for Anxiety)
33 52 - 19
Study Outcomes
Incremental cost-effective ratio, b
incremental
cost per unit change in anxiety score
PDM dominates UC in
70% of probabilistic
sensitivity analysis
iterations