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Abstract

Introduction: To investigate short-and long-term outcomes, quality of life (QOL), costs and cost-effectiveness in patients with a hematological malignancy (HM) admitted to the ICU of a tertiary care hospital. Hypothesis: Critical care treatment of patients with a HM is a cost-effective intervention. Methods: A 1 year prospective observational cohort analysis was performed. All consecutive adult patients with HM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Data concerning the HM, demographics, comorbidity, severity of illness, organ failures, and outcomes were collected. QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D (EQ-5D), Medical Outcomes Study 36-item Short Form Health Survey (SF-36)). Cost data were restricted to hospital-related direct costs. Statistical significance was attained at P<0.05. Results: 85 patients (58% males, 48% high grade HM) with median age of 60 years (IQR 48-71) and Charlson comorbidity index of 3 (IQR 2-4) were included. The HM was controlled, new diagnosis, or progressive in 34%, 31%, and 35% respectively. At ICU admission, APACHE II and SOFA scores were 21 (IQR 17-29) and 6 (3-9) respectively; 29 patients (34%) were neutropenic. Reasons for ICU admission were mainly medical (91%). During ICU stay, median SOFA scores were 6 (IQR 4-8). Therapeutic limitations were set in 25 patients (29%). ICU, hospital, 3 months and 1 year mortality were 21%, 34%, 42% and 66% respectively. QOL decreased 3 months after ICU discharge, improved after 1 year, mainly mentally, but remained under baseline level. This was significant for vitality (P.03) (SF-36), and usual activities (P<.001) (EQ-5D). After 1 year, survivors perceived their QOL as acceptable. Costs per hospital survivor were $ 66856 and costs per quality adjusted life year $ 6460. Conclusions: Mortality after ICU admission increased substantially over a 1 year period. QOL improved but remained under baseline level. Critical care treatment of patients with HM was found to be a cost-effective intervention.