Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study*

Jukarainen, Sakari; Mildh, Henriikka; Pettilä, Ville; Häkkinen, Unto; Peltola, Mikko; Ala‐Kokko, Tero; Reinikainen, Matti; Vaara, Suvi T.

doi:10.1097/ccm.0000000000004210

Cited by 11 publications

(11 citation statements)

References 39 publications

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“…There are limited data on cost‐utility of ICU treatment in general and even more so for COVID‐19. In a recent Finnish study [ 23 ], the costs per QALY for ICU treatment averaged £6367 ($7789; €7600), which was comparable to the costs per QALY of our study (£7511; $9179; €8969). Different countries use limit ranges for cost‐effectiveness of medical measures.…”

Section: Discussionsupporting

confidence: 81%

“…Intensive care treatment costs are disproportionally high, considering ICU beds make up less than 10% of all in‐patient beds [ 5 , 23 ]. Data regarding daily treatment costs are rare and subject to significant fluctuations, ranging between £1020 ($1248; €1218) and £2720 ($3328; €3247) [ 4 , 23 , 24 , 25 ]. The average daily treatment costs in the non‐COVID‐19 control cohort of our study lie within the range of these previous reports.…”

Section: Discussionmentioning

confidence: 99%

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Intensive care unit resources and patient‐centred outcomes in severe COVID‐19: a prospective single‐centre economic evaluation

et al. 2022

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Summary During the COVID‐19 pandemic, ICU bed shortages sparked a discussion about resource allocation. We aimed to analyse the value of ICU treatment of COVID‐19 from a patient‐centred health economic perspective. We prospectively included 49 patients with severe COVID‐19 and calculated direct medical treatment costs. Quality of life was converted into aggregated quality‐adjusted life years using the statistical remaining life expectancy. Costs for non‐treatment as the comparator were estimated using the value of statistical life year approach. We used multivariable linear or logistic regression to identify predictors of treatment costs, quality of life and survival. Mean (SD) direct medical treatment costs were higher in patients in ICU with COVID‐19 compared with those without (£60,866 (£42,533) vs. £8282 (£14,870), respectively; p < 0.001). This was not solely attributable to prolonged ICU length of stay, as costs per day were also higher (£3115 (£1374) vs. £1490 (£713), respectively; p < 0.001), independent of overall disease severity. We observed a beneficial cost‐utility value of £7511 per quality‐adjusted life‐year gained, even with a more pessimistic assumption towards the remaining life expectancy. Extracorporeal membrane oxygenation therapy provided no additional quality‐adjusted life‐year benefit. Compared with non‐treatment (costs per lost life year, £106,085), ICU treatment (costs per quality‐adjusted life‐year, £7511) was economically preferable, even with a pessimistic interpretation of patient preferences for survival (sensitivity analysis of the value of statistical life year, £48,848). Length of ICU stay was a positive and extracorporeal membrane oxygenation a negative predictor for quality of life, whereas costs per day were a positive predictor for mortality. These data suggest that despite high costs, ICU treatment for severe COVID‐19 may be cost‐effective for quality‐adjusted life‐years gained.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Intensive care unit resources and patient‐centred outcomes in severe COVID‐19: a prospective single‐centre economic evaluation

et al. 2022

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“…Therefore, 87 studies met the eligibility criteria and were included in this analysis (Fig. 1) [16–102]. The κ value for agreement on full text was excellent (0.90, p <0.01).…”

Section: Resultsmentioning

confidence: 99%

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

et al. 2021

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Summary Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta‐analysis to assess hospital re‐admission rates following critical care admission and to explore potential re‐admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re‐admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re‐admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta‐analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re‐admission episodes. Pooled estimates for hospital re‐admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re‐admission is common in survivors of critical illness. Careful attention to the management of pre‐existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at‐risk critical care survivors can reduce the risk of subsequent rehospitalisation.

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“…In a previous study investigating cost-effectiveness using a cohort of critically ill patients, the parameter clearly illustrated an improvement in the efficiency of medical allocation with an increasing survival rate during ICU admission [ 21 , 28 , 29 ]. In another study, cost-effectiveness with total medical cost and quality-adjusted life years was used to estimate the relationship between medical cost and resource use [ 30 , 31 ]. In our study, we demonstrated an improvement in cost-effectiveness as well as a decrease in medical costs per hospitalization and a shortened duration of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

et al. 2022

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Background Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined. Methods We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs. Results Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = − $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = − $1806/year [95% CI − $2432 to − $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs. Conclusions We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses.

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Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study*

Cited by 11 publications

References 39 publications

Intensive care unit resources and patient‐centred outcomes in severe COVID‐19: a prospective single‐centre economic evaluation

Intensive care unit resources and patient‐centred outcomes in severe COVID‐19: a prospective single‐centre economic evaluation

Hospital re‐admission after critical care survival: a systematic review and meta‐analysis

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

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