Understanding economic outcomes in critical care

Current Opinion in Critical Care

Volumn 12, Issue 5, 2006, Pages 399-404

  Kahn, Jeremy M ^a  

^a UNIVERSITY OF WASHINGTON   (United States)

Author keywords

Critical care; Economic outcomes

Indexed keywords

COST EFFECTIVENESS ANALYSIS; COST OF ILLNESS; CRITICAL ILLNESS; ECONOMIC ASPECT; HUMAN; INTENSIVE CARE; LENGTH OF STAY; REVIEW; THEORETICAL MODEL; TREATMENT OUTCOME;

COST-BENEFIT ANALYSIS; CRITICAL CARE; CRITICAL ILLNESS; HEALTH CARE COSTS; HEALTH EXPENDITURES; HUMANS; INTENSIVE CARE UNITS;

EID: 33748415731     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/01.ccx.0000244117.08753.38     Document Type: Review

References (39)

1. Halpern NA, Bettes L, Greenstein R. Federal and nationwide intensive care units and healthcare costs: 1986-1992. Crit Care Med 1994; 22:2001-2007.
2. Jacobs P, Noseworthy TW. National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 1990; 18:1282-1286.
3. Cooper LM, Linde-Zwirble WT. Medicare intensive care unit use: analysis of incidence, cost, and payment. Crit Care Med 2004; 32:2247-2253.
4. Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004; 32:1254-1259.
5. Luce JM, Rubenfeld GD. Can healthcare costs be reduced by limiting intensive care at the end of life? Am J Respir Crit Care Med 2002; 165:750-754.
6. Cowan C, Catlin A, Smith C, et al. National health expenditures, 2002. Healthc Financ Rev 2004; 25:143-166.
7. Stevens K, McCabe C, Jones C, et al. The incremental cost effectiveness of withdrawing pulmonary artery catheters from routine use in critical care. Appl Health Econ Health Policy 2005; 4:257-264. An example of a well-conducted economic evaluation conducted alongside a clinical trial, in this case a trial of pulmonary artery catheterization in critical illness.
8. Ramsey S, Willke R, Briggs A, et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health 2005; 8:521-533. An excellent overview of the methodology for performing CEAs alongside clinical trials.
9. Krinsley JS, Jones RL. Cost analysis of intensive glycemic control in critically ill adult patients. Chest 2006; 129:644-650. This study demonstrates how micro-costing techniques can be used to estimate the attributable cost of a modifiable exposure such as ventilator-associated pneumonia.
10. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005; 33:2184-2193.
11. Walter LC, Davidowitz NP, Heineken PA, et al. Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA 2004; 291:2466-2470.
12. Rossi C, Simini B, Brazzi L, et al. Variable costs of ICU patients: a multicenter prospective study. Intensive Care Med 2006; 32:545-552. A thorough accounting of the variable costs of critical care.
13. Roberts RR, Frutos PW, Ciavarella GG, et al. Distribution of variable vs fixed costs of hospital care. JAMA 1999; 281:644-649.
14. Dasta JF, McLaughlin TP, Mody SH, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005; 33:1266-1271. In delineating the attributable cost of mechanical ventilation, these authors elegantly demonstrate that subsequent (marginal) ICU days are much less expensive than the first ICU day.
15. Rubenfeld GD, Angus DC, Pinsky MR, et al. Outcomes research in critical care: results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research. The Members of the Outcomes Research Workshop. Am J Respir Crit Care Med 1999; 160:358-367.
16. Truog RD, Brock DW, Cook DJ, et al. Rationing in the intensive care unit. Crit Care Med 2006; 34:958-963; quiz 971. This report from the Task Force on Values, Ethics, and Rationing in Critical Care categorizes the different types of rationing decisions, and places them within the necessary context of cost and resource utilization in the ICU.
17. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335:1864-1869.
18. Kress JP, Pohlman AS, O'Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477.
19. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354:449-461. An excellent example of a clinical intervention that reduces length of stay and organ failures, but not mortality. The decision to implement such a therapy must be based on the presumed relationship between length of stay, organ failures and costs, rather than patient-centered outcomes.
20. The Acute Respiratory Distress Syndrome Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006; 354: 1671-1684.
21. Collard HR, Saint S, Matthay MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003; 138:494-501.
22. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994; 330:377-381.
23. Cook DJ, Griffith LE, Walter SD, et al. The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001; 5:368-375.
24. Manns B, Doig CJ, Lee H, et al. Cost of acute renal failure requiring dialysis in the intensive care unit: clinical and resource implications of renal recovery. Crit Care Med 2003; 31:449-455.
25. Rapoport J, Teres D, Zhao Y, et al. Length of stay data as a guide to hospital economic performance for ICU patients. Med Care 2003; 41:386-397.
26. Ost DE, Hall CS, Joseph G, et al. Decision analysis of antibiotic and diagnostic strategies in ventilator-associated pneumonia. Am J Respir Crit Care Med 2003; 168:1060-1067.
27. Institute for Healthcare Improvement. Ventilator bundle. Cambridge: IHI, http://www.ihi.org
28. Dellinger RP, Carlet JM, Masur H, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32:858-873.
29. Takala J, Ruokonen E, Webster NR, et al. Increased mortality associated with growth hormone treatment in critically ill adults. N Engl J Med 1999; 341:785-792.
30. Angus DC, Linde-Zwirble WT, Clermont G, et al. Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis. Crit Care Med 2003; 31:1-11.
31. American Thoracic Society. Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research. Am J Respir Crit Care Med 2002;165:540-550.
32. Coughlin MT, Angus DC. Economic evaluation of new therapies in critical illness. Crit Care Med 2003; 31:S7-S16.
33. Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related blood-stream infection. JAMA 1999; 282:554-560.
34. Pronovost PJ, Needham DM, Waters H, et al. Intensive care unit physician staffing: financial modeling of the Leapfrog standard. Crit Care Med 2004; 32:1247-1253.
35. Van den Berghe G, Wouters PJ, Kesteloot K, et al. Analysis of healthcare resource utilization with intensive insulin therapy in critically ill patients. Crit Care Med 2006; 34:612-616. A CEA using micro-costing methods. The costs savings of the therapy are driven by a small reduction in ICU length of stay, creating the potential for bias in the incremental cost difference.
36. Luce BR, Manning WG, Siegel JE, et al. Estimating costs in cost-effectiveness analysis. In: Gold MR, Siegel JE, Russell LB, Weinstin MC, editors. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996. pp. 176-213.
37. Ramsey SD, Berry K, Etzioni R, et al. Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. N Engl J Med 2003; 348:2092-2102.
38. Wan IY, Toma TP, Geddes DM, et al. Bronchoscopic lung volume reduction for end-stage emphysema: report on the first 98 patients. Chest 2006; 129:518-526.
39. Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J 2006; [Epub ahead of print]. This study demonstrates how both the costs and the effectiveness of an ICU-based intervention are highly dependent on the perspective and time-horizon of the analysis.