The Social Economic Return of a Positive End-Expiratory Pressure-Based Lung Recruitment Clinical Trial Program in Patients With Acute Respiratory Distress Syndrome

Objectives: This study aimed to estimate the socioeconomic return from the value of lives saved by the protocol indicated by the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART). ART was conducted through a multicenter randomized trial at 120 intensive care units from 9 countries, enrolling adults with moderate to severe acute respiratory distress syndrome. It investigated whether lung recruitment associated with positive end-expiratory pressure titration according to the best respiratory system compliance decreases 28-day mortality of patients compared with a conventional low-positive end-expiratory pressure strategy. Methods: The value of lives saved was estimated by considering whether the trial findings were implemented in the eligible patient populations for 1 year, and then the social economic return was computed by subtracting the clinical trial costs from the gross benefit. The return was computed by subtracting the ART costs from its gross benefit. Results: The ART net benefit is approximately 152 million dollars if it is implemented in 50% of eligible patients in Brazil under the baseline assumptions. For every dollar spent in the clinical trial, a return of 114 dollars was achieved in Brazil alone. If the trial findings are implemented in all eligible patients, then the trial return would be 229.5 dollars for every dollar invested with a net benefit of 304 million dollars. Conclusions: These findings highlight the substantial economic benefit of clinical trials on acute respiratory distress syndrome treatments for society. It also points out that the public return of clinical trials can be potentialized when the new trial findings are fully implemented on eligible patients.