Abstract
IntroductionThe purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation.MethodsFive-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs, hospital costs and post-hospital health care costs per survivor, costs per life year gained, and costs per quality-adjusted life year gained of patients admitted to a single ICU were assessed.ResultsOne hundred ten of 354 patients (31%) were alive 5 years after hospital discharge. The mean health status index of 5-year survivors was 0.77 (95% confidence interval 0.70 to 0.85). Women rated their health-related quality of life significantly better than men did (0.87 versus 0.74; P < 0.05). Costs per hospital discharge survivor were 49,952 €. Including the costs of post-hospital discharge health care incurred during their remaining life span, the total costs per life year gained were 10,107 €. Considering 5-year survivors only, the costs per life year gained were calculated as 9,816 € or 14,487 € per quality-adjusted life year gained. Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 €.ConclusionPatients who leave the hospital following cardiac arrest without severe neurological disabilities may expect a reasonable quality of life compared with age- and gender-matched controls. Quality-adjusted costs for this patient group appear to be within ranges considered reasonable for other groups of patients.
Highlights
The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation
ICUs consume a large proportion of hospital budgets yet care for a minority of CI = confidence interval; CPR = cardiopulmonary resuscitation; GCS = Glasgow Coma Scale; Health-related quality of life (HRQL) = health-related quality of life; HSI = health status index; ICU = intensive care unit; quality-adjusted life years (QALYs) = quality-adjusted life year; SAPS II = Simplified Acute Physiology Score II; SF-36 = Medical Outcome Survey Short Form-36 questionnaire; SOFA = Sequential Organ Failure Assessment; TISS-28 = Therapeutic Intervention Scoring System; total maximum SOFA (TMS) = total maximum Sequential Organ Failure Assessment
Patient outcomes Of 354 patients admitted to the ICU with cardiac arrest, 204 patients (58%) died prior to discharge from the hospital, either during their ICU stay (n = 171) or later on the ward (n = 26), not including 7 patients who were discharged with severe disabilities
Summary
The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation. Since the 1960s, immediate cardiopulmonary resuscitation (CPR) has been considered life-saving for sudden cardiac arrest [2], and following successful CPR, patients are routinely admitted to intensive care units (ICUs) to manage both the causes and acute sequelae. ICUs consume a large proportion of hospital budgets yet care for a minority of CI = confidence interval; CPR = cardiopulmonary resuscitation; GCS = Glasgow Coma Scale; HRQL = health-related quality of life; HSI = health status index; ICU = intensive care unit; QALY = quality-adjusted life year; SAPS II = Simplified Acute Physiology Score II; SF-36 = Medical Outcome Survey Short Form-36 questionnaire; SOFA = Sequential Organ Failure Assessment; TISS-28 = Therapeutic Intervention Scoring System; TMS = total maximum Sequential Organ Failure Assessment. A sensitivity analysis was conducted to model the impact of changes in utility (life years gained and health status index [HSI]) on the development of cost-outcome indices
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