Is it 'Worthwhile' to continue treating patients with a prolonged stay (>14 days) in the ICU?: An economic evaluation
Is it 'Worthwhile' to continue treating patients with a prolonged stay (>14 days) in the ICU?: An economic evaluation
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DOI：
10.1378/chest.114.1.192
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发表时间：
1998-07-01
期刊：
影响因子：
9.6
通讯作者：
Gafni, A
中科院分区：
文献类型：
--
作者：
Heyland, DK;Konopad, E;Gafni, A
目的：比较长期留在ICU的患者继续护理的成本和后果，以及建议的撤除支持的政策的成本和后果。设计：使用前瞻性队列研究的数据进行经济评估。地点：三级护理医院的成人内外科ICU。患者：连续入住ICU的患者。干预：不。主要结果指标：我们对ICU中的每一位患者进行了成本核算分析，并对患者进行了跟踪，直到入院12个月，并评估了生存质量的组成部分。结果：在研究期间，690名患者进入ICU。只有61例(9%)患者在ICU停留14天，这组患者的平均住院时间为24.5(+/-11.7)天，住院时间为57.9(+/-56.9)天。12个月时，27例(44%)存活。总体而言，在ICU短期或长期住院的患者在12个月时的平均生活质量得分没有差异。每名患者平均每天的ICU费用为1,565美元(加拿大)，导致整个队列的总费用为1,917,382加元，在同一时期，58名患者的生命支持被取消。平均而言，患者在ICU又活了一天，在医院又活了两天，所有患者最终都去世了。当停止治疗时，治疗这一队列的费用是156,465加元。增量成本-效果比为每挽救一条生命可增加65,219美元，或每一生命年可节省4,350美元。结论：在ICU生活时间较长的患者有相当比例的危重病人存活下来，而且他们的长期生活质量似乎是合理的。我们的数据表明，对ICU住院时间较长的患者进行持续治疗可能代表着医院资源的有效利用，应该在地方预算的背景下考虑。
Objective: To compare the cost and consequences of a policy of continuing to care for patients with a prolonged stay in the ICU with a proposed policy of withdrawing support,Design: Economic evaluation using data derived from a prospective cohort study.Setting: Adult medical/surgical ICU in a tertiary care hospital.Patients: Consecutive patients admitted to the ICU.Intervention: None.Main outcome measures: We performed a cost-accounting analysis on each patient in the ICU and followed up patients until 12 months after admission to ICU and assessed components of quality of Life in survivors.Results: During the study period, 690 patients were admitted to the ICU. Only 61 (9%) patients remained in the ICU for >14 days, For this group, the mean length of stay in the ICU was 24.5 (+/-11.7) days and duration in hospital was 57.9 (+/-56.9) days. At 12 months, 27 (44%) were alive. Overall, the mean quality of life score at 12 months did mot differ between patients with a short or prolonged stay in the ICU. The average ICU cost per day per patient was $1,565 (Canadian) resulting in a total cost for the whole cohort of Can $1,917,382, Over the same time period, 58 patients had life support withdrawn. On average, patients survived another day in the ICU, 2 more clays in hospital, and all patients ultimately died. When treatment was discontinued, the costs of treating this cohort was Can $156,465. The incremental cost-effectiveness ratio is Can $65,219 per life saved or Can $4,350 per life-year saved.Conclusions: A considerable proportion of patients with a prolonged length of slay in the ICU survive their critical illness, Furthermore, their long-term quality of life seems reasonable. Our data suggest that continuing treatment for patients with a prolonged ICU stay may represent an efficient use of hospital resources and should be considered in the context of local budgets.