The inverse relationship between cost and survival in the critically ill cancer patient

Turnbull, A. D.; Carlon, Graziano C.; Baron, R.M.; Sichel, William; Young, Charles W.; Howland, William S.

doi:10.1097/00003246-197901000-00005

Cited by 69 publications

(17 citation statements)

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“…[2][3][4] The costs of intensive care consume a large fraction of the available funds and can account for a disproportionate amount of resources dedicated to patients with a poor prognosis. [5][6][7][8] A recent consensus conference concluded that "future outcome evaluation of intensive care should incorporate quality of life [measures]" and that "further research into patient preferences as well as cost-effectiveness and cost utility studies are necessary to develop guidelines for use of scarce ICU resources which reflect the values of both society and individual patients." 9 The SUPPORT study examined patient preferences but did not specifically include surgical patients; rather, it focused on patients with a limited prognosis, with an expected 50% death rate.…”

Section: Discussionmentioning

confidence: 99%

Survival and Functional Outcome After Prolonged Intensive Care Unit Stay

et al. 2000

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Section: Discussionmentioning

confidence: 99%

Survival and Functional Outcome After Prolonged Intensive Care Unit Stay

et al. 2000

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“…One patient took early Intensive care clinicians are frequently faced with ethical dilemmas concerning the appropriate extent of medical intervention for critically ill patients whose prognosis is poor (Thibault et al, 1980;Wanzer et al, 1984). Not only can intensive care be mentally and physically distressing for patients, relatives and staff but it is also expensive, especially for non-survivors (Cullen et al, 1976;Detsky et al, 1981;Turnbull et al, 1979). Both for a humane approach to the management of critically ill patients and to ensure that limited resources are used appropriately, it is therefore important to avoid admitting patients who cannot benefit from intensive care and to limit further aggressive therapy when the prognosis is clearly hopeless.…”

Section: Methodsmentioning

confidence: 99%

Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy

Yau

Rohatiner²,

Lister³

et al. 1991

Br J Cancer

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Summary Ninety-two consecutive adult patients admitted with acute life-threatening complications of haematological malignancy were studied to determine long term outcome. The quality of life was evaluated in seven long term survivors who are currently alive more than I year after hospital discharge using three validated methods: the Nottingham Health Profile, the Hospital Anxiety and Depression Scale and the Perceived Quality of Life Scale. Patients were also asked whether they had returned to work, whether their daily activities were limited and whether they would be willing to undergo intensive care again under the same circumstances. The in-hospital mortality rate was 77%. Median duration of long term survival was 23 months (range 6 weeks to 8 years). Long term survival did not appear to be related to either the aetiology or the severity of the acute illness, but seemed to be determined solely by the nature and progress of the underlying malignancy. The quality of life of six of the seven long term survivors is good, while that of the other is acceptable. None of the patients reported any increased limitation of their daily activities, five had returned to full time employment and all seven stated that they would be willing to undergo intensive care again under the same circumstances.

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“…Other research without controls for illness severity has also found a positive relationship between increases in therapy and the probability of death. [2][3][4] In Equation 3 we again investigate the statistical relationship between TISS points and survival, this time controlling for severity of illness. We did this by introducing an explicit measure of severity of acute illness (the Acute Physiology Score) we derive a U-shaped curve for nonsmoking, average-age, male medical patients with a physiology score of 15-the average physiology (see Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Severity of illness and the relationship between intensive care and survival.

Scheffler¹,

Knaus²,

Wagner³

et al. 1982

Am J Public Health

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Currently about 15 per cent of hospital costs are attributed to intensive care. Research using statistical models has not adequately demonstrated that therapy in intensive care units (ICUs) is associated with reductions in the probability of death. In a study of 613 consecutive admissions to a multidisciplinary ICU, we reevaluate the relationship between ICU care and survival using a new acute physiology scoring system to control for the severity of illness of the patient population.When our severity of illness index was employed, we found a statistically significant and nonlinear relationship between the use of intensive medical care and the probability of survival. This statistical relationship Hospital-based intensive care accounts for about 15 per cent of hospital costs and is widely believed by physicians to be efficacious in treating individual patients.* However, studies of intensive care unit (ICU) populations have not been able to statistically demonstrate that the increased utilization of therapy in ICUs lowers the probability of death.2-4 Likewise, analyses of area-wide data have in many instances failed to find a measurable health benefit related to the availability of health care resources.5-9 In this paper we present results indicating that the impact of intense medical care on the probability of death is nonlinear and statistically measurable when the analysis controls for severity of illness. Materials and Methods Data BaseTo perform the analysis, we collected detailed data on 613 consecutive admissions to the 16-bed medical and surgi- produced a U-shaped curve with three distinct segments. The first segment exhibited an overall decrease in the probability of death with increasing therapy (275 admissions); the second segment, a fairly stable survival rate (281 admissions). Only in the third segment, where there were 57 admissions, did we find an overall increase in the probability of death as utilization of therapy increased.These findings suggest that quantitative measurement of severity of illness, when used in clinical studies, could produce improved insights into the relationship between therapy and health outcomes.(Am J Public Health 1982; 72:449-454.) cal ICU of the George Washington University Medical Center (GWUMC). The GWUMC ICU treats a wide variety of patients with acute medical and surgical problems with the exception of myocardial infarctions and burns.During the eight-month study period, we collected information on the patient's past medical history; indications for ICU admission; the amount and type of therapy each patient received; the severity of acute illness; and outcome, defined as dead or alive when discharged from the hospital. Information regarding past medical history included age, sex, operative status, smoking history measured in pack years,** and the use of alcohol if it contributed to past or present medical problems.To measure therapy we collected Therapeutic Intervention Scoring System (TISS) points during each shift the patient was in the ICU.'0 TISS us...

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The inverse relationship between cost and survival in the critically ill cancer patient

Cited by 69 publications

References 0 publications

Survival and Functional Outcome After Prolonged Intensive Care Unit Stay

Survival and Functional Outcome After Prolonged Intensive Care Unit Stay

Long term prognosis and quality of life following intensive care for life-threatening complications of haematological malignancy

Severity of illness and the relationship between intensive care and survival.

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