Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients

Čubro, Hajrunisa; Somun-Kapetanović, Rabija; Thiéry, Guillaume; Talmor, Daniel; Gajic, Ognjen

doi:10.5492/wjccm.v5.i2.150

Cited by 28 publications

(20 citation statements)

References 40 publications

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“…[4] The contribution of ICU costs to total public hospital expenditure is therefore likely to be lower in SA than in countries with higher ICU bed-to-patient ratios such as the USA, with an estimated 20 -30 beds per 100 000 population. [16] The cost per ICU day (USD2 000/EUR1 815 in the trauma ICU and USD1 263/EUR1 146 in the combined ICU) in the current study is higher than the cost per day of USA193 in a medical ICU in a tertiary hospital in Sarajevo, [17] and EUR144 across 13 ICUs in Hungary. Our cost per ICU day is also higher than the USD255…”

Section: Discussionmentioning

confidence: 53%

Cost of intensive care services at a central hospital in South Africa

Mahomed

2018

S Afr Med J

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Section: Discussionmentioning

confidence: 53%

Cost of intensive care services at a central hospital in South Africa

Mahomed

2018

S Afr Med J

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“…To improve critical care service delivery in resource-limited settings, decision-makers must accept that high-quality, equitable intensive care services are necessary to achieve the Sustainable Development Goals and health security [34,106]. These services should include basic hospital resources, a reliable supply chain for essential medications and equipment [107], and a plan for human resource development [1].…”

Section: Strengthening Health Systemsmentioning

confidence: 99%

Global Critical Care: Moving Forward in Resource-Limited Settings

Dı́az

Riviello

Papali

et al. 2019

Annals of Global Health

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IntroductionCritical care is an important component of health care systems around the world (Figure 1). Caring for critically ill patients in resource-rich settings typically involves treatment in intensive care units (ICUs) staffed with highly specialized health care professionals, systematic monitoring and use of high-cost technology [1]. Unfortunately, these components are not always available in resource-limited settings [2, 3], where the burden of disease is greater [4], outcomes are poorer [5, 6], and local characteristics require context-specific approaches to the organization of critical care services.Critical care delivery, education, and research require a global perspective based on epidemiologic considerations. The burden of critical illness in resource-limited settings is not well described, but the best available estimates suggest that it may be greater than in resource-rich settings [7, 8] due to deficiencies in access to health care, emergency triage, and lack of early recognition [9][10][11]. Mortality for adults with sepsis [5, 12, 13] and acute respiratory distress syndrome (ARDS) [14][15][16] in resource-limited settings is higher than in resource-rich settings, and decedents are usually young (mean age 35 years vs. 61 years in United States) [12,17], which contributes to a greater negative downstream social and economic impact. Similarly, there is a higher burden of sepsis and respiratory infection mortality among children [18][19][20][21]. Recent epidemiological changes in global health have created a ' double burden of disease' to resource-limited settings [9,22] due to an increase in the prevalence of non-communicable diseases combined with lack of improvement in the long-recognized higher burden of communicable diseases, maternal and child mortality, malnutrition, and human immunodeficiency virus (HIV)-related complications.Health care professionals from resource-rich and resource-limited settings should take a global perspective on critical care for both ethical and practical reasons. Ethically, health care professionals, trainees, professional societies, non-governmental organizations (NGOs), and international organizations from resource-rich settings have the capacity of deploying resources to improve outcomes for critically ill patients in resource-limited settings [11,23,24]. Assistance can include financial help, knowledge exchange in the form of research and educational partnerships, and capacity building in operations and implementation science. From a practical point of view, supporting resource-limited settings is also important given that inter-related economies, Caring for critically ill patients is challenging in resource-limited settings, where the burden of disease and mortality from potentially treatable illnesses is higher than in resource-rich areas. Barriers to delivering quality critical care in these settings include lack of epidemiologic data and context-specific evidence for medical decision-making, deficiencies in health systems organization and resources, and in...

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“…This results in frequent triage decisions [32], which likely increases preventable mortality [45]. Even though costs of care in ICUs of resource-limited settings are only a fraction of those encountered in HICs [46], expenses for ICU care are usually to a large extent covered by the patient's family and relatives in LMICs. Unwanted consequences can be denial or refusal of ICU admission of poor patients, but also the premature withdrawal of lifesaving interventions [47,48].…”

Section: Poor Availability Of Critical Carementioning

confidence: 99%

“…Unfortunately, there is a dearth of evidence directly from these settings to confirm this. The only economic evaluation of an ICU in Bosnia and Herzegovina concluded that critical care was highly costeffective in their setting [46]. A study from Brazil showed that the implementation of a sepsis management protocol was associated with an absolute reduction of 18% in mortality and with cost savings [55].…”

Section: Benefit Of Critical Care Among Regionsmentioning

confidence: 99%