COST AND OUTCOME OF INTENSIVE-CARE FOR PATIENTS WITH AIDS, PNEUMOCYSTIS-CARINII PNEUMONIA, AND SEVERE RESPIRATORY-FAILURE
COST AND OUTCOME OF INTENSIVE-CARE FOR PATIENTS WITH AIDS, PNEUMOCYSTIS-CARINII PNEUMONIA, AND SEVERE RESPIRATORY-FAILURE
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DOI：
10.1001/jama.273.3.230
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发表时间：
1995-01-18
影响因子：
120.7
通讯作者：
SCITOVSKY, AA
中科院分区：
文献类型：
--
作者：
WACHTER, RM;LUCE, JM;SCITOVSKY, AA
客观。-确定与获得性免疫缺陷综合征（AIDS）相关的卡氏肺孢子虫肺炎（PCP）和严重呼吸衰竭患者入住重症监护室（ICU）相关的成本和结局。生存和成本效益分析。设置。一家大型的市立教学医院，为贫困人口服务。从1981年到1991年，因AIDS、PCP和呼吸衰竭接受插管和机械通气的便秘患者（n=113）。该队列被分为三组进行分析：1981年至1985年（第一阶段，n=43），1986年至1988年（第二阶段，n=33），1989年至1991年（第三阶段，n=37）入住ICU的患者。住院费用和生存时间;每年挽救生命的成本，使用零成本，零生命的代价。113例因PCP和呼吸衰竭接受机械通气的患者中有28例（25%）存活至出院：I期43例中有6例（14%），II期33例中有13例（39%），III期37例中有9例（24%）（P= 0.04）。整个队列的ICU后入院费用平均为57874美元，在三个时期内保持相对稳定。幸存者的护理费用比出院前死亡的人要昂贵得多。ICU入院和随后住院治疗的费用平均为每年挽救生命174781美元;第一阶段为305795美元，第二阶段为94528美元，第三阶段为215233美元。生存率的提高和ICU住院时间的缩短导致了第二时代成本效益的提高，而近年来相反的趋势导致了成本效益的恶化。在第三个时期，医院死亡率的最强预测因素是入院时的低CD 4细胞计数和机械通气期间气胸的发生。在艾滋病流行的前8年，对PCP和严重呼吸衰竭患者的重症监护的成本效益有所改善，但近年来有所下降，目前低于许多公认的医疗干预措施。
Objective.-To determine the costs and outcomes associated with intensive care unit (ICU) admission for patients with acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), and severe respiratory failure.Design.-Survival and cost-effectiveness analysis.Setting.-A large municipal teaching hospital serving an indigent population.Patients.-Consecutive patients intubated and mechanically ventilated for AIDS, PCP, and respiratory failure from 1981 through 1991 (n=113). The cohort was separated into three groups for analysis: patients admitted to the ICU in 1981 through 1985 (era I, n=43), those admitted in 1986 through 1988 (era II, n=33), and those admitted in 1989 through 1991 (era III, n=37).Main Outcome Measures.-Hospital charges and survival time; cost per year of life saved, using a zero-cost, zero-life assumption.Results.-Twenty-eight (25%) of the 113 patients mechanically ventilated for PCP and respiratory failure survived to hospital discharge: six (14%) of 43 in era I, 13 (39%) of 33 in era II, and nine (24%) of 37 in era III (P=.04). Post-ICU admission charges averaged $57 874 for the entire cohort, remaining relatively stable across the three eras. Cost of care for survivors was significantly more expensive than for those dying before discharge. The cost of ICU admission and subsequent hospitalization averaged $174 781 per year of life saved; $305 795 in era 1, $94 528 in era II, and $215 233 in era III. Improved survival rates and shorter lengths of ICU stay led to the improved cost-effectiveness in era II, while the opposite trends resulted in worsening cost-effectiveness in recent years. The strongest predictors of hospital mortality in era III were low CD4 cell counts on hospital admission and the development of pneumothorax during mechanical ventilation.Conclusions.-The cost-effectiveness of intensive care for patients with PCP and severe respiratory failure improved during the first 8 years of the AIDS epidemic but fell in recent years such that it is now below that of many accepted medical interventions.