Abstract
BackgroundThe long-term economic and quality-of-life outcomes of patients admitted to intensive care unit (ICU) with acute respiratory distress syndrome are not well understood. In this study, we investigate 1-year costs, survival and quality of life following ICU admission in patients who required mechanical ventilation for acute respiratory distress syndrome.MethodsEconomic analysis of data collected alongside a UK-based multi-centre randomised, controlled trial, aimed at comparing high-frequency oscillatory ventilation with conventional mechanical ventilation. The study included 795 critically ill patients admitted to ICU. Hospital costs were assessed using daily data. Post-hospital healthcare costs, patient out-of-pocket expenses, lost earnings of survivors and their carers and health-related quality of life were assessed using follow-up surveys.ResultsThe mean cost of initial ICU stay was £26,857 (95 % CI £25,222–£28,491), and the average daily cost in ICU was £1738 (CI £1667–£1810). Following hospital discharge, the average 1-year cost among survivors was £7523 (CI £5692–£9354). The mean societal cost at 1 year was £44,077 (£41,168–£46,985), and the total societal cost divided by the number of 1-year survivors was £90,206. Survivors reported significantly lower health-related quality of life than the age- and sex-matched reference population, and this difference was more marked in younger patients.ConclusionsGiven the high costs and low health-related quality of life identified, there is significant scope for further research aimed at improving care in this in-need patient group.Trial registrationISRCTN10416500
Highlights
The long-term economic and quality-of-life outcomes of patients admitted to intensive care unit (ICU) with acute respiratory distress syndrome are not well understood
Among the 795 patients included in the analysis, 343 patients died in ICU and 47 died in hospital after ICU discharge
Compared to 1-year survivors, non-survivors were older, had a higher Acute Physiology (APACHE) II score, lower partial pressure of arterial oxygen (PaO2):fraction of inspired oxygen (FiO2) ratio and were less likely to have been admitted in surgery. 1-year survivors who have completed both 6 and 12 months questionnaires were younger and had lower APACHE II scores than 1-year survivors with incomplete information
Summary
The long-term economic and quality-of-life outcomes of patients admitted to intensive care unit (ICU) with acute respiratory distress syndrome are not well understood. We investigate 1-year costs, survival and quality of life following ICU admission in patients who required mechanical ventilation for acute respiratory distress syndrome. A comprehensive evaluation of these alternative therapies requires the assessment of long-term mortality outcomes and the consideration of resource use and patient quality of life [13,14,15,16,17]. Survivors of ARDS may require on-going treatments and rehabilitation following hospital discharge [1, 19, 26] as well as extensive support from carers [6], which may lead to an important economic cost to the health sector and the society as a whole [35, 37]. The measurement and reporting of costs and quality-adjusted life years (QALYs) in ICU populations is vital to allow health service and policy advances
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