Abstract
IntroductionEconomic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country.MethodsIn this retrospective cohort study, data from a regional tertiary hospital in northeast Thailand and the regional death registry were linked and used to assess patient survival time after ICU discharge. Adult ICU patients aged at least 15 years who had been discharged alive from an ICU between 1 January 2004 and 31 December 2005 were included in the study, and the death registry was used to determine deaths occurring in this cohort up to 31st December 2010. These data were used in conjunction with standard mortality life tables to estimate annual mortality and life expectancy.ResultsThis analysis included 10,321 ICU patients. During ICU admission, 3,251 patients (31.5%) died. Of 7,070 patients discharged alive, 2,527 (35.7%) were known to have died within the five-year follow-up period, a mortality rate 2.5 times higher than that in the Thai general population (age and sex matched). The mean LE was estimated as 18.3 years compared with 25.2 years in the general population.ConclusionsPost-ICU patients experienced much higher rates of mortality than members of the general population over the five-year follow-up period, particularly in the first year after discharge. Further work assessing Health Related Quality of Life (HRQOL) in both post-ICU patients and in the general population in developing countries is needed.
Highlights
Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival
Demographics and ICD10 codes in the group of patients who were discharged alive differed slightly from those in patients who died within the intensive care unit (ICU) (Table 1)
The group of post-ICU patients who died within five years of discharge tended to be older and much less likely to have ICD10 codes relating to injury, poison and other external causes than those who were alive after five years (Table 2)
Summary
Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country. There is growing interest not just in the effectiveness of such interventions at reducing mortality, but in their cost-effectiveness, and formal economic evaluation is increasingly used to aid decisions about allocation of scarce health care resources in these settings [12]. Such analyses consider both costs of the interventions and the associated health benefits. The aim of this study was to quantify the long-term survival of post-ICU patients in Thailand and to estimate life expectancy (LE) in this population
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