Outcomes and healthcare-associated costs one year after intensive care-treated cardiac arrest

Efendijev, Ilmar; Folger, Daniel; Raj, Rahul; Reinikainen, Matti; Pekkarinen, Pirkka T.; Litonius, Erik; Skrifvars, Markus B.

doi:10.1016/j.resuscitation.2018.06.028

Cited by 40 publications

(31 citation statements)

References 45 publications

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“…One previous study reported OHCA survivors to have combined pre-, in- and post-hospital healthcare-associated costs of €37,000 in 2013 euros in a 6-month follow-up [31]. In a recent study of single-centre data published by our group, combined in- and post-hospital healthcare costs in 1-year follow-up were €59,000 for OHCA and €84,000 for IHCA hospital survivors in 2013 euros [18].…”

Section: Discussionmentioning

confidence: 98%

“…All social insurance reimbursements during the year following hospital admission were included. Effective cost per survivor (ECPS) was calculated by dividing the sum of total costs for all patients with the number of survivors [18]. We adjusted all costs to the value of euro in the year 2013 according to the consumer price index (CPI) in Finland.…”

Section: Methodsmentioning

confidence: 99%

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Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study

et al. 2019

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Background Organ dysfunction is common after cardiac arrest and associated with worse short-term outcome, but its impact on long-term outcome and treatment costs is unknown. Methods We used nationwide registry data from the intensive care units (ICU) of the five Finnish university hospitals to evaluate the association of 24-h extracerebral Sequential Organ Failure Assessment (24h-EC-SOFA) score with 1-year survival and healthcare-associated costs after cardiac arrest. We included adult cardiac arrest patients treated in the participating ICUs between January 1, 2003, and December 31, 2013. We acquired the confirmed date of death from the Finnish Population Register Centre database and gross 1-year healthcare-associated costs from the hospital billing records and the database of the Finnish Social Insurance Institution. Results A total of 5814 patients were included in the study, and 2401 were alive 1 year after cardiac arrest. Median (interquartile range (IQR)) 24h-EC-SOFA score was 6 (5–8) in 1-year survivors and 7 (5–10) in non-survivors. In multivariate regression analysis, adjusting for age and prior independency in self-care, the 24h-EC-SOFA score had an odds ratio (OR) of 1.16 (95% confidence interval (CI) 1.14–1.18) per point for 1-year mortality. Median (IQR) healthcare-associated costs in the year after cardiac arrest were €47,000 (€28,000–75,000) in 1-year survivors and €12,000 (€6600–25,000) in non-survivors. In a multivariate linear regression model adjusting for age and prior independency in self-care, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €170 (95% CI €150–190) in the cost per day alive in the year after cardiac arrest. In the same model, an increase of one point in the 24h-EC-SOFA score was associated with an increase of €4400 (95% CI €3300–5500) in the total healthcare-associated costs in 1-year survivors. Conclusions Extracerebral organ dysfunction is associated with long-term outcome and gross healthcare-associated costs of ICU-treated cardiac arrest patients. It should be considered when assessing interventions to improve outcomes and optimize the use of resources in these patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2359-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study

et al. 2019

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“…The total healthcare cost variable included the index university hospital treatment costs, rehabilitation hospital costs, and social security costs up to 1 year after admission. The cost variables have previously been described in detail [2,16,17]. We adjusted all costs according to the average annual Consumer Price Index in Finland into euros, based on the exchange rate in 2019 (data from Statistics Finland):…”

Section: Outcome and Cost Variablesmentioning

confidence: 99%

“…There are no limits to or recommendations for cost-effective treatments in terms of ECPS or ECPIS, and these measures cannot be directly compared to QALY. Still, compared to severe TBI (with an ECPS of approximately €80,000 and an ECPIS of approximately €145,000 [16,17]), SAH (an ECPS of approximately €70,000, an ECPIS of approximately €95,000 [17]), acute ischemic stroke (an ECPS of approximately €55,000, an ECPIS of approximately €105,000 [17]), and cardiac arrest (an ECPS of approximately €95,000, an ECPIS of approximately €100,000 [2]), ICH surgery seems to be cost-effective in terms of survival, with an ECPS of approximately €110,000, though not in terms of independent living (with an ECPIS of approximately €335,000).…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium study

et al. 2020

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Background The benefits of early surgery in cases of superficial supratentorial spontaneous intracerebral hemorrhage (ICH) are unclear. This study aimed to assess the association between early ICH surgery and outcome, as well as the cost-effectiveness of early ICH surgery. Methods We conducted a retrospective, register-based multicenter study that included all patients who had been treated for supratentorial spontaneous ICH in four tertiary intensive care units in Finland between 2003 and 2013. To be included, patients needed to have experienced supratentorial ICHs that were 10–100 cm3 and located within 10 mm of the cortex. We used a multivariable analysis, adjusting for the severity of the illness and the probability of surgical treatment, to assess the independent association between early ICH surgery (≤ 1 day), 12-month mortality rates, and the probability of survival without permanent disability. In addition, we assessed the cost-effectiveness of ICH surgery by examining the effective cost per 1-year survivor (ECPS) and per independent survivor (ECPIS). Results Of 254 patients, 27% were in the early surgery group. Overall 12-month mortality was 39%, while 29% survived without a permanent disability. According to our multivariable analysis, early ICH surgery was associated with lower 12-month mortality rates (odds ratio [OR] 0.22, 95% confidence intervals [CI] 0.10–0.51), but not with a higher probability of survival without permanent disability (OR 1.23, 95% CI 0.59–2.56). For the early surgical group, the ECPS and ECPIS were €111,409 and €334,227, respectively. For the non-surgical cohort, the ECPS and ECPIS were €76,074 and €141,471, respectively. Conclusions Early surgery for superficial ICH is associated with a lower 12-month mortality risk but not with a higher probability of survival without a permanent disability. Further, costs were higher and cost-effectiveness was, thus, worse for the early surgical cohort.

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“…Many patients resuscitated from out-of-hospital cardiac arrest (OHCA) suffer from hypoxic-ischaemic brain injury (HIBI) and die in the intensive care unit (ICU) without regaining consciousness [1,2]. Accurate prognostication is of paramount importance to prevent prolonged futile intensive care and, on the other hand, to avoid withdrawal of care in those who have a chance to recover [3,4]. Current guidelines recommend a multimodal approach in the prognostication of cardiac arrest (CA) patients including clinical examination, radiological imaging, neurophysiological assessment, and biomarkers [5].…”

Section: Introductionmentioning

confidence: 99%

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

et al. 2020

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Purpose: Neurofilament light (NfL) is a biomarker reflecting neurodegeneration and acute neuronal injury, and an increase is found following hypoxic brain damage. We assessed the ability of plasma NfL to predict outcome in comatose patients after out-of-hospital cardiac arrest (OHCA). We also compared plasma NfL concentrations between patients treated with two different targets of arterial carbon dioxide tension (PaCO 2), arterial oxygen tension (PaO 2), and mean arterial pressure (MAP). Methods: We measured NfL concentrations in plasma obtained at intensive care unit admission and at 24, 48, and 72 h after OHCA. We assessed neurological outcome at 6 months and defined a good outcome as Cerebral Performance Category (CPC) 1-2 and poor outcome as CPC 3-5. Results: Six-month outcome was good in 73/112 (65%) patients. Forty-eight hours after OHCA, the median NfL concentration was 19 (interquartile range [IQR] 11-31) pg/ml in patients with good outcome and 2343 (587-5829) pg/ml in those with poor outcome, p < 0.001. NfL predicted poor outcome with an area under the receiver operating characteristic curve (AUROC) of 0.98 (95% confidence interval [CI] 0.97-1.00) at 24 h, 0.98 (0.97-1.00) at 48 h, and 0.98 (0.95-1.00) at 72 h. NfL concentrations were lower in the higher MAP (80-100 mmHg) group than in the lower MAP (65-75 mmHg) group at 48 h (median, 23 vs. 43 pg/ml, p = 0.04). PaCO 2 and PaO 2 targets did not associate with NfL levels. Conclusions: NfL demonstrated excellent prognostic accuracy after OHCA. Higher MAP was associated with lower NfL concentrations.

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Outcomes and healthcare-associated costs one year after intensive care-treated cardiac arrest

Abstract: In-ICU CA patients had the lowest one-year survival with the effective cost per survivor three times higher than for OHCAs.

Cited by 40 publications

References 45 publications

Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study

Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study

Early surgery for superficial supratentorial spontaneous intracerebral hemorrhage: a Finnish Intensive Care Consortium study

Neurofilament light as an outcome predictor after cardiac arrest: a post hoc analysis of the COMACARE trial

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