Avoidable intensive care unit resource use and costs of unvaccinated patients with COVID-19: a historical population-based cohort study

Bagshaw, Sean M.; Abbott, Annalise; Beesoon, Sanjay; Zuege, Danny J.; Wasylak, Tracy; Manns, Braden; Nguyễn, Thanh Xuân

doi:10.1007/s12630-022-02299-w

Cited by 6 publications

(16 citation statements)

References 17 publications

(19 reference statements)

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“…First, the study by Bagshaw et al used "publicly available age-stratified aggregate data on COVID-19 infections, vaccination status, and health service use provided by Alberta Health." 1 A major error in this data was misattribution of vaccination status. Those single-or double-dose vaccinated within 14 days were considered in the unvaccinated or partially vaccinated group respectively.…”

Section: Effect Of Vaccination On Icu Admissions Were Over-estimatedmentioning

confidence: 99%

“…The authors in Bagshaw et al concluded that their findings "have important implications for discourse on the relative balance of increasingly stringent public health protection (restrictions), including mandatory vaccination policies, and the sustainability and function of health system infrastructure and capacity during the ongoing COVID-19 pandemic." 1 We are not so sure.…”

Section: Policy Implications At Best Unclearmentioning

confidence: 99%

“…The authors in Bagshaw et al wrote that "baseline funded ICU bed capacity in Alberta [was] (n=173 beds)," as asserted by Alberta Health Services later in the pandemic. 1 However, previous publications, by some of the same authors, gave different figures, ranging from 351 to 430 funded adult ICU beds in Alberta. 20,21 In 2015 the authors published an estimate of 268 publicly funded adult ICU beds in 2010.…”

Section: Effect Of Vaccination On Access To Acute Care and All-cause ...mentioning

confidence: 99%

“…First, "increasingly stringent public health protection (restrictions)" 1 have not translated into better control of COVID-19 cases nor healthcare infrastructure. [23][24][25][26] Similarly, "mandatory vaccination policies" 1 in Canada and the United States have not translated into meaningful increases in population vaccination rates (i.e., generally <1% absolute increases).…”

Section: Policy Implications At Best Unclearmentioning

confidence: 99%

“…This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated." 1 Using this publication as an example, we aim to demonstrate how data and policy implications can be misinterpreted.…”

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confidence: 99%

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Avoidable Intensive Care Resource Use of Unvaccinated COVID-19 Patients: Interpretation and Policy Implications

Joffe¹,

Milburn²

2022

Preprint

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We aim to use a recently published research study as an example in order to demonstrate how data can be misinterpreted and result in deriving misleading policy implications. Bagshaw et al wrote that unvaccinated patients with COVID-19 in Alberta, Canada “had substantially greater rates of ICU admissions, ICU bed days, and ICU related costs than vaccinated patients did. This increased resource use would have been potentially avoidable had these unvaccinated patients been vaccinated.” The authors in Bagshaw et al then concluded that their findings “have important implications for discourse on the relative balance of increasingly stringent public health protection (restrictions), including mandatory vaccination policies, and the sustainability and function of health system infrastructure and capacity during the ongoing COVID-19 pandemic.” Here we show the following. First, the effect of vaccination on intensive care admissions were grossly over-estimated. Second, an effect of vaccination on access to acute care and on all-cause excess deaths was grossly over-stated. Third, policy implications were overstated and at best unclear. Overall, the data cannot support what Bagshaw et al called “increasingly stringent public health protection (restrictions), including mandatory vaccination policies”.

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Section: Effect Of Vaccination On Icu Admissions Were Over-estimatedmentioning

confidence: 99%

Section: Policy Implications At Best Unclearmentioning

confidence: 99%

Section: Effect Of Vaccination On Access To Acute Care and All-cause ...mentioning

confidence: 99%

Section: Policy Implications At Best Unclearmentioning

confidence: 99%

mentioning

confidence: 99%

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Avoidable Intensive Care Resource Use of Unvaccinated COVID-19 Patients: Interpretation and Policy Implications

Joffe¹,

Milburn²

2022

Preprint

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Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU With COVID-19*

Diepen

McAlister

Chu

et al. 2023

Critical Care Medicine

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OBJECTIVES: Although COVID-19 vaccines can reduce the need for intensive care unit admission in COVID-19, their effect on outcomes in critical illness remains unclear. We evaluated outcomes in vaccinated patients admitted to the ICU with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the association between vaccination and booster status on clinical outcomes. DESIGN: Retrospective cohort. SETTING AND PATIENTS: All patients were admitted to an ICU between January 2021 (after vaccination was available) and July 2022 with a diagnosis of COVID-19 based on a SARS-CoV-2 polymerase chain reaction test in Alberta, Canada. INTERVENTIONS: None. MEASUREMENT: The propensity-matched primary outcome of all-cause in-hospital mortality was compared between vaccinated and unvaccinated patients, and vaccinated patients were stratified by booster dosing. Secondary outcomes were mechanical ventilation (MV) duration ICU length of stay (LOS). MAIN RESULTS: The study included 3,293 patients: 743 (22.6%) were fully vaccinated (54.6% with booster), 166 (5.0%) were partially vaccinated, and 2,384 (72.4%) were unvaccinated. Unvaccinated patients were more likely to require invasive MV (78.4% vs 68.2%), vasopressor use (71.1% vs 66.6%), and extracorporeal membrane oxygenation (2.1% vs 0.5%). In a propensity-matched analysis, in-hospital mortality was similar (31.8% vs 34.0%, adjusted odds ratio [OR], 1.25; 95% CI, 0.97–1.61), but median duration MV (7.6 vs 4.7 d; p < 0.001) and ICU LOS (6.6 vs 5.2 d; p < 0.001) were longer in unvaccinated compared to fully vaccinated patients. Among vaccinated patients, greater than or equal to 1 booster had lower in-hospital mortality (25.5% vs 40.9%; adjusted OR, 0.50; 95% CI, 0.0.36–0.68) and duration of MV (3.8 vs 5.6 d; p = 0.025). CONCLUSIONS: Nearly one in four patients admitted to the ICU with COVID-19 after widespread COVID-19 vaccine availability represented a vaccine-breakthrough case. Mortality risk remains substantial in vaccinated patients and similar between vaccinated and unvaccinated patients after the onset of critical illness. However, COVID-19 vaccination is associated with reduced ICU resource utilization and booster dosing may increase survivability from COVID-19-related critical illness.

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A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19

Bagshaw

Abbott

Beesoon

et al. 2023

Can J Public Health

Self Cite

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Objective The coronavirus disease 2019 (COVID-19) pandemic has precipitated a prolonged public health crisis. Numerous public health protections were widely implemented. The availability of effective and safe vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented an opportunity to resolve this crisis; however, vaccine uptake was slow and inconsistent. This study evaluated the potential for preventable hospitalizations and avoidable resource use among eligible non-vaccinated persons hospitalized for COVID-19 had these persons been vaccinated. Methods This was a retrospective, population-based cohort study. The population-at-risk were persons aged ≥ 12 years in Alberta (mid-year 2021 population ~ 4.4 million). The primary exposure was vaccination status. The primary outcome was hospitalization with confirmed SARS-CoV-2, and secondary outcomes included avoidable hospitalizations, avoidable hospital bed-days, and the potential cost avoidance related to COVID-19. The study inception period was 27 September 2021 to 25 January 2022. Data on COVID-19 hospitalizations, vaccination status, health services, and costs were obtained from the Government of Alberta and from the Discharge Abstract Database. Results Hospitalizations occurred in 3835, 1907, and 481 persons who were non-vaccinated, fully vaccinated, and boosted (risk of hospitalization/100,000 population: 886, 92, and 43), respectively. For non-vaccinated persons compared with fully vaccinated and boosted persons, the risk ratios (95%CI) of hospitalization were 9.7 (7.9–11.8) and 20.6 (17.9–23.6), respectively. For non-vaccinated persons, estimates of avoidable hospitalizations and bed-days used were 3439 and 36,331 if fully vaccinated and 3764 and 40,185 if boosted. Estimates of cost avoidance for non-vaccinated persons were $101.46 million if fully vaccinated and $110.24 million if boosted. Conclusion Eligible non-vaccinated persons with COVID-19 had tenfold and 21-fold higher risks of hospitalization relative to whether they had been fully vaccinated or boosted, resulting in considerable avoidable hospital bed-days and costs. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-023-00777-2.

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Avoidable intensive care unit resource use and costs of unvaccinated patients with COVID-19: a historical population-based cohort study

Cited by 6 publications

References 17 publications

Avoidable Intensive Care Resource Use of Unvaccinated COVID-19 Patients: Interpretation and Policy Implications

Avoidable Intensive Care Resource Use of Unvaccinated COVID-19 Patients: Interpretation and Policy Implications

Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU With COVID-19*

A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19

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