Abstract
BackgroundNeurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU).MethodsWe used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003–2013. Outcome variables were one-year mortality and permanent disability. Total healthcare costs included the index university hospital costs, rehabilitation hospital costs and social security costs up to one year. All costs were converted to euros based on the 2013 currency rate.ResultsIn total 7044 patients were included (44% with TBI, 13% with ICH, 27% with SAH, 16% with AIS). In comparison to TBI, ICH was associated with the highest risk of death and permanent disability (OR 2.6, 95% CI 2.1–3.2 and OR 1.7, 95% CI 1.4–2.1), followed by AIS (OR 1.9, 95% CI 1.5–2.3 and OR 1.5, 95% CI 1.3–1.8) and SAH (OR 1.8, 95% CI 1.5–2.1 and OR 0.8, 95% CI 0.6–0.9), after adjusting for severity of illness. SAH was associated with the highest mean total costs (€51,906) followed by ICH (€47,661), TBI (€43,916) and AIS (€39,222). Cost per independent survivor was lower for TBI (€58,497) and SAH (€96,369) compared to AIS (€104,374) and ICH (€178,071).ConclusionNeurocritical illnesses are costly and resource-demanding diseases associated with poor outcomes. Intensive care of patients with TBI or SAH more commonly result in independent survivors and is associated with lower total treatments costs compared to ICH and AIS.
Highlights
Neurocritical illness is a growing healthcare problem with profound socioeconomic effects
The Glasgow Coma Scale (GCS) score was lower among patients with traumatic brain injury (TBI) or intracerebral hemorrhage (ICH) compared to subarachnoid hemorrhage (SAH) or acute ischemic stroke (AIS)
Patients with ICH had the highest Simplified Acute Physiology Score (SAPS) Simplified Acute Physiology Score II (II) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores followed by patients with TBI, SAH or AIS
Summary
Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU). Neurocritical illnesses, including traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS), are major killers and impose a growing socioeconomic burden around the world [1,2,3,4]. The most severe illnesses or injuries are treated at specialized intensive care units (ICU). Finland has a public tax-funded healthcare system, allowing every citizen to be treated at the right level of care at every step (including acute care and rehabilitation), independent of for example. All the most severe and resourcedemanding cases are treated at the university hospital level, enabling comprehensive cost-analysis studies. The Social Insurance Institution (Kela) in Finland covers all Finnish citizens regardless of personal insurance status
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