Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis.
Frode Lindemark,Frode Lindemark,Øystein Ariansen Haaland,Reidar Kvåle,Hans Flaatten,Hans Flaatten,Ole Frithjof Norheim,Ole Frithjof Norheim,Kjell Arne Johansson,Kjell Arne Johansson +9 more
Reads0
Chats0
TLDR
The extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals are described and a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease is performed.Abstract:
Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more cost-effective. On average, ICU admission versus general ward care was cost-effective at a threshold of €22,000/QALY (p = 95%). According to the individualized cost-effectiveness information, one in six ICU admissions was not cost-effective at a threshold of €64,000/QALY. Almost half of these admissions that were not cost-effective can be regarded as acceptable when weighted by severity of disease in terms of expected lifetime health. Overall, existing ICU services represent reasonable resource use, but considerable uncertainty becomes evident when disaggregating into individualized results.read more
Citations
More filters
Journal ArticleDOI
Interprofessional Shared Decision-Making in the ICU: A Systematic Review and Recommendations From an Expert Panel.
Andrej Michalsen,Ann C. Long,Freda DeKeyser Ganz,Douglas B. White,Hanne Irene Jensen,Victoria Metaxa,Christiane S. Hartog,Jos M. Latour,Robert D. Truog,Jozef Kesecioglu,Anna R Mahn,J. Randall Curtis +11 more
TL;DR: Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions in ICUs.
Journal ArticleDOI
Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?
TL;DR: It is reviewed and rejected claims that frailty-based triage would represent unjust discrimination on the grounds of age or disability, and three important steps to improve the ethical incorporation of frailty into triage are outlined.
Journal ArticleDOI
Examining Equity Effects of Health Interventions in Cost-Effectiveness Analysis: A Systematic Review.
TL;DR: The number of equity-informative CEAs is increasing, and the wide range of equity criteria, diseases, interventions, settings, and populations represented suggests that broad application of these methods is feasible but will require further refinement.
Journal ArticleDOI
Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions
Journal ArticleDOI
Cost-Effectiveness Studies in the ICU: A Systematic Review.
TL;DR: Despite critical care being a significant healthcare cost burden there remains a paucity of studies in the literature evaluating its cost effectiveness, and a systematic search of the English-language literature for cost-effectiveness analyses published from 1993 to 2018 in critical care was conducted.
References
More filters
Journal Article
R: A language and environment for statistical computing.
TL;DR: Copyright (©) 1999–2012 R Foundation for Statistical Computing; permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and permission notice are preserved on all copies.
Journal ArticleDOI
Methods for the economic evaluation of health care programmes
TL;DR: Using archival material supplemented by interviews with community physicians, Jane Lewis shows how 'public health' and 'preventive medicine' have been supplanted as the central concern of medicine by curative and acute specialties.
Methods for the Economic Evaluation of Health Care Programmes, Second Edition
TL;DR: The second edition of the first edition of this book was published in 1987 as discussed by the authors, and the second edition includes new chapters on collection and analysis of data and on the presentation and use of data.
Book
Methods for the Economic Evaluation of Health Care Programmes
TL;DR: The role of health economics is becoming firmly established in the evaluation of health care programs and can serve as a basic text for students hoping to understand the complex methodologies of economic evaluation.
Journal ArticleDOI
Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine
Gillian D Sanders,Peter J. Neumann,Anirban Basu,Dan W. Brock,David Feeny,Murray Krahn,Karen M. Kuntz,David O. Meltzer,Douglas K Owens,Lisa A. Prosser,Joshua A. Salomon,Mark Sculpher,Thomas A Trikalinos,Louise B. Russell,Joanna E. Siegel,Theodore G. Ganiats +15 more
TL;DR: The Second Panel on Cost-Effectiveness in Health and Medicine reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations, including the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.