Intensive Care Unit Costs Research Articles

Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit.

IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost.MethodsUsing a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables.ResultsMRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention.ConclusionsActive screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0876-y) contains supplementary material, which is available to authorized users.

Costs and Utilization of Operating Rooms in a Public Hospital in Trinidad, West Indies.

A top-down evaluation of the costs of operating rooms (ORs) is not commonly done because it is relevant mostly in a publicly funded system. This study was conducted to determine the costs and utilization of ORs in a public hospital in Trinidad, West Indies, for two one-year periods using a top-down model. Quantitative observational study.Main Outcome Measures: A "cost-block" model suggested for evaluation of intensive care unit costs was adapted to suit ORs. Data were obtained from personal interviews, records, and surveys from the appropriate hospital departments. Adjusted OR utilization times also were recorded for both years. The total annual costs of 4 ORs for the years 2006 and 2009 were approximately US $2.2 and $3.2 million, respectively. Capital expenditure contributed to 70% of the costs, followed by consumables (15%) and medical staff salary (8%). The daily cost of running the ORs was US $6242 in 2006, which rose to $8873 in 2009. The cost of unutilized OR time was approximately US $298,342 in 2006 and was reduced to $198,315 during 2009. The adapted cost-block model was useful to evaluate the costs of ORs in a public hospital in Trinidad and can be used from the government's expenditure perspective. Because the cost of running the ORs was high, efficiency must be improved to minimize waste.

Impact of Clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: A multicenter retrospective study of inpatients, 2009-2011

The recent epidemiologic changes of Clostridium difficile-associated diarrhea (CDAD) have resulted in substantial economic burden to U.S. acute care hospitals. Past studies evaluating CDAD-attributable costs have been geographically and demographically limited. Here, we describe CDAD-attributable burden in inpatients, overall, and in vulnerable subpopulations from the Premier hospital database, a large, diverse cohort with a wide range of high-risk subgroups. Discharges from the Premier database were retrospectively analyzed to assess length of stay (LOS), total inpatient costs, readmission, and inpatient mortality. Patients with CDAD had significantly worse outcomes than matched controls in terms of total LOS, rates of intensive care unit (ICU) admission, and inpatient mortality. After adjustment for risk factors, patients with CDAD had increased odds of inpatient mortality, total and ICU LOS, costs, and odds of 30-, 60- and 90-day all-cause readmission versus non-CDAD patients. CDAD-attributable costs were higher in all studied vulnerable subpopulations, which also had increased odds of 30-, 60- and 90-day all-cause readmission than those without CDAD. Given the significant economic impact CDAD has on hospitals, prevention of initial episodes and targeted therapy to prevent recurrences in vulnerable patients are essential to decrease the overall burden to hospitals.

Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy.

Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy. ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model. The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were €922 per patient. Mean total costs were €56 083 per patient in the ERAS group and €63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were €9139 and €13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151). ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.

Effects of hand massage and acupressure therapy for mechanically ventilated patients

&lt;p class="Default"&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This research is an experimental study (randomized controlled) which is carried out to investigate the effect on anxiety of hand massage and acupressure therapy in patients having mechanical ventilation support.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method and material: &lt;/strong&gt;This randomized controlled research was conducted in Intensive care units of Ege University Faculty of Medicine, Department of Chest Diseases and Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital between the dates 18 June 2007 and 3 May 2008. The research sample was comprised of a total of 70 patients who met the research criteria in the hand massage and acupressure (n=35) and control (n =35) groups. Data were collected by using Patient Information Form, Patient Record Form and Visual Analogue Scale. It was following patients in experimental and control groups during seven days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea of patients in control group. These patients weren’t used hand massage and acupressure therapy. The patients in experimental group weren’t used hand massage and acupressure therapy in the first and seventh days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea. The other days, it was used hand massage and acupressure therapy. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea This research is an experimental study (randomized controlled) which is carried out to investigate the effect on anxiety of hand massage and acupressure therapy in patients having mechanical ventilation support. Research was conducted in Intensive care units of Ege University Faculty of Medicine, Department of Chest Diseases and Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital between the dates 18 June 2007 and 3 May 2008. The research sample was comprised of a total of 70 patients who met the research criteria in the hand massage and acupressure (n=35) and control (n =35) groups. Data were collected by using Patient Information Form, Patient Record Form and Visual Analogue Scale. It was following patients in experimental and control groups during seven days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea of patients in control group. These patients weren’t used hand massage and acupressure therapy. The patients in experimental group weren’t used hand massage and acupressure therapy in the first and seventh days. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea. The other days, it was used hand massage and acupressure therapy. Hand massage and acupressure therapy was limited to 18 minutes. It was recorded physiological indicators of anxiety, perceived anxiety and dyspnoea before and after hand massage and acupressure therapy. It was calculated intensive care unit costs and determined duration in intensive care unit after discharge of patients in experimental and control groups. In the data analysis were used chi square, repeated measures analysis of variance, independent samples t test, paired samples t test, LSD (Least-Significant difference) tests.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Results: &lt;/strong&gt;According to the research findings, it wasn’t found significant as clinical which is the statistically significant difference in the physiological indicators of anxiety, perceived anxiety and dyspnoea except from oxygen saturation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; In conclusion, our results suggest that hand massage and acupressure therapy might effectively relieve perceived dyspnoea and anxiety and reduce physiological indicators of anxiety in patients having mechanical ventilation support. The study provides a research-based intervention model for clinicians caring for MVP.&lt;/p&gt;

The challenge of acute kidney injury : Cross-sectional study on prevalence and costs in a university intensive care unit

The prognosis of intensive care patients with acute kidney injury (AKI), which is associated with increased mortality is still poor. Current data on the prevalence and the resulting costs of AKI and an overview of the most common diagnoses associated with AKI in German intensive care units (ICU) are lacking. In this retrospective study all adult admissions (> 18Jahre) in the five ICUs at the University Clinic Regensburg (in total 78 beds) from1 January 2011 to 31 December 2013 were evaluated. The ICU diagnoses commonly associated with AKI were identified using the international classification of diseases 10 (ICD 10). The length of ICU and hospital stays and AKI-associated hospital costs in the diagnosis-related groups (DRG) based reimbursement system were compared. A total of 891 ICU patients with AKI were classified according to the ICD 10 code. Acute respiratory distress syndrome (ARDS), myocardial infarction (MI) and sepsis were the three most common ICU conditions associated with AKI. A total of 1103 patients were admitted with 1 of these 3 main diagnoses and 249 (22.6 %) of these patients developed AKI. Patients with AKI had significantly longer mean ICU and hospital stays compared to patients without AKI (18.6 vs 5.1 days and 23.8 vs. 10.4 days, respectively, p < 0.001). The presence of AKI in critically ill patients with ARDS, MI and sepsis resulted in additional costs of 2,019,120.42€ at the University Hospital of Regensburg in 2013. Acute kidney injury in critically ill patients represents a significant medical and socioeconomic burden. Early recognition of patients at risk, coordinated research into novel interventions and establishment of the National Acute Kidney Injury Network for implementation of evidence-based therapies may be the next steps to decrease the incidence and severity of AKI and save costs for the national healthcare system.

Patients characteristics and outcomes of prolonged mechanical ventilation after critical illness transferred to a weaning unit

Recent trends seem to point out that growing numbers of patients requiring prolonged mechanical ventilation (PMV) and protracted weaning after critical illness with eventually account for a large portion of all Intensive Care Unit (ICU) cost and bed occupancy. Specialized Weaning Unit (WU), may facilitate weaning through focused multidisciplinary expert team, but due to considerable variability of interventions and organization outcomes remain unclear.

Weaning unit and prolonged mechanical ventilation after critical illness

Patients requiring prolonged mechanical ventilation (PMV) and protracted and weaning after critical illness is rising. The consequences are higher Intensive Care Unit (ICU) costs and length of hospital stay. Weaning Unit (WU) with a multidisciplinary expert team may facilitate weaning and hospital discharge.

A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) <60% predicted value (P = 0.02, bootstrap 63%) and chronic obstructive pulmonary disease (COPD; P = 0.035, bootstrap 57%). The following model was developed to estimate the total costs: 10 523 + 1894 × COPD + 2376 × DLCO < 60%. The comparison between predicted and observed costs was repeated in 1000 bootstrapped samples to verify the stability of the model. The two values were not different (P > 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements.

ANÁLISE DE CUSTOS DA DIÁRIA DE UTI PEDIÁTRICA DE UM HOSPITAL UNIVERSITÁRIO

RESUMO Este trabalho teve por objetivo analisar se o valor repassado pelo Sistema Único de Saúde (SUS) é suficiente para cobrir os custos das diárias da Unidade de Terapia Intensiva (UTI) pediátrica em hospitais Universitários de Ensino através de uma pesquisa de campo realizada no hospital Universitáro do Triângulo Mineiro. O equilíbrio da sustentabilidade econômico-financeira do hospital depende da gestão de custos em hospitais que estão coveniados ao SUS como fonte de receita. A metodologia utilizada caracteriza-se por um estudo de caso e, para a coleta de dados, foi utilizada a técnica de observação e análise documental, evidenciando um déficit entre a receita e a despesa do centro de custo das diárias de UTI pediatria. Verificou-se, também, que os gestores hospitalares necessitam da sustentabilidade econômico-financeira das organizações hospitalares, sendo necessário, para isso, que a Tabela SUS seja reajustada para se adequar aos reais custos de uma entidade hospitalar.

Remifentanil for analgesia and sedation in mechanically ventilated patients in intensive care unit

To prospectively assess the effect of remifentanil for analgesia and sedation, the impact on sustenance duration of mechanical ventilation and hemodynamics, and also its adverse reaction in the mechanically ventilated patients in the intensive care unit (ICU). Sixty patients with invasive mechanical ventilation forever 24 hours after tumor operation were randomly allocated to fentanyl group (n = 30) or remifentanil group n = 30) to receive a persistent infusion of either fentanyl or remifentanil for sedation and analgesia. The level of analgesia was assessed according to facial pain scale (FPS), while the level of sedation was assessed according to the Ramsay score (RS). A propofol infusion was started if additional sedation was necessary. During the therapy, the daily awakening procedure was performed, and the scores of FPS and RS and the vital signs were recorded respectively before and after medication. The number of patients receiving additional propofol infusion, and number of daily interruption of medication and that of daily arousal, the duration of mechanical ventilation, ICU length of stay, and ICU cost were recorded. Furthermore, the incidence of adverse reactions was documented. The ideal targets of analgesia and sedation were reached in both groups. There were nearly no significant differences between the groups with respect to the effect of sedation and analgesia. However, the FPS scores in fentanyl group at the 30 minutes of the medication were. obviously higher than those of remifentanil group (3. 70 ± 1.20 vs. 2.70 ± 1.17, P<0.05). The mean arterial pressure (MAP,mm Hg, I mm Hg = 0.133 kPa) of remifentanil group at 30 minutes was significantly lower than that of fentanyl group (72.9 ± 6.9 vs. 77.6 ± 9.1, P<0.05). There was no difference between two groups with respect to the other vital signs. More patients in fentanyl group needed the additional propofol infusion (9 vs. 8) and interruption of medication (12 vs. 4, both P<0.05). The spontaneous breathing frequency (RRs, bpm) in patients of remifentanil group was lower obviously at 30 minutes and 1, 6, 24 hours than that of fentanyl group (7.0 ± 2.8 vs. 10.4 ± 3.5, 5.4 ± 3.4 vs. 10.6 ± 3.6, 5.4 ± 3.0 vs. 7.2 ± 3.1 , 6.1 ± 3.0 vs. 9.2 ± 3.4, all P< 0.05) . The duration of mechanical ventilation (hours) and ICU length of stay (hours) were shortened in remifentanil group comparted with fentanyl group (73.6 ± 26.7 vs. 94.9 ± 37.3, 125.9 ± 37.1 vs. 150.8 ± 50.9, both P<0.05). With respect to the cost of hospitalization (10 thousand), no significant difference was found between two groups (6.06 ± 2.29 vs. 5.83 ± 2.38, P>0.05). The number of patients showing hypotension was much more in remifentanil group than that of fentanyl group (8 vs. 2, P<0.05). The effect of remifentanil was similar to that of the conventional therapy. Remifentanil gives rapid effect, shortens the duration of mechanical ventilation, reduces the dosage of propofol, and has no severe adverse effect.

Successful Implementation of a Packed Red Blood Cell and Fresh Frozen Plasma Transfusion Protocol in the Surgical Intensive Care Unit

BackgroundBlood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU).Study DesignWe performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received.Results829 total patients were included in the analysis (PRE, n=372; POST, n=457). Despite higher mean age (56 vs. 52 years, p=0.01) and APACHE II scores (12.5 vs. 11.2, p=0.006), mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03) and fresh frozen plasma (0.3 vs. 1.2, p=0.007) in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39). There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80) in the POST cohort after controlling for age, illness severity and amount of blood products transfused.ConclusionsImplementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.

The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock

PurposeThe costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes. MethodsA prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand. ResultsA total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were $2716.5 ($1296.1-$5367.6) and $599.9 ($414.3-$948.6) per day. The ICU costs accounted for 64.7% of the hospital costs. In 2008 to 2011, the ICU costs significantly decreased by 40% from $3542.5 to $2124.9, whereas, the daily ICU costs decreased only 3.3% from $609.7 to $589.7. By multivariate logistic regression analysis, age, nosocomial or ICU infection, admission from the emergency department, number of organ failures, ICU length of stay, and fluid balance the first 72 hours were independently associated with ICU costs. ConclusionThe ICU costs of severe sepsis management significantly declined in our study. However, the ICU costs were a financial burden accounting for two thirds of the hospital costs. It is essential for intensivists to contribute a high standard of care within a restricted budget.

The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units

ObjectivesTo estimate the daily cost of intensive care unit (ICU) stays via micro-costing. MethodsA multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospital's perspective (reference year 2009) based on unitary cost data. ResultsOne hundred and four patients were included (mean age: 62.3±14.9 years, mean SAPS II: 51.5±16.1, mean SOFA on the study day: 6.9±4.3). Over 24hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32±05:00h. The total daily cost per patient was €1425±€520 (95% CI=€1323 to €1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€842±€521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r=0.271, P=0.006) and the bedside-time given by caregivers (r=0.716, P<0.0001). ConclusionThe average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources.

Simulation analysis of hospital intensive care unit reimbursement policies from the triple bottom line perspective

We consider how alternative intensive care unit (ICU) cost reimbursement policies impact an ICU’s ability to satisfy the triple bottom line (TBL) of sustainability. Towards this end, we develop a discrete event simulation model of an ICU and use simulation optimization to identify ‘near-optimal’ ICU cost reimbursement policies, staffing levels, and sizes (number of beds) that allow investors to reap profits while still respecting the TBL of sustainability. The studied ICU is reimbursed based on either (1) the total time patients spend in the ICU or (2) the total time medical doctors spend treating patients. Results show that reimbursement Policy 1 generates higher profits but is associated with socially and environmentally unsustainable outcomes including high numbers of early patient discharges and readmissions and a large ICU size. Reimbursement Policy 2, on the other hand, respects the TBL of sustainability to a much greater degree while still yielding a healthy profit.

Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system

ObjectivesThere is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of...

Comparison of Patient Costs in Internal Medicine and Anaesthesiology Intensive Care Units in a Tertiary University Hospital.

The allocation of the Gross Domestic Product (GDP) to health is limited, therefore it has made a need for professional management of health business. Hospital managers as well as employees are required to have sufficient knowledge about the hospital costs. Hospital facilities like intensive care units that require specialization and advanced technology have an important part in costs. For this purpose, cost analysis studies should be done in the general health business and special units separately. In this study we aimed to compare the costs of anaesthesiology and internal medicine intensive care units (ICU) roughly. After approval of this study by Gazi University Faculty of Medicine Ethics Committee, the costs of 855 patients that were hospitalized, examined and treated for at least 24 hours in internal medicine and anaesthesiology ICUs between January 2012-August 2013 (20 months period) were taken and analyzed from chief staff of the Department of Information Technology, Gazi University Hospital. At the end of the study, we observed clear differences between internal medicine and anaesthesiology ICUs arising from transactions and patient characteristics of units. We stated that these differences should be considered by Social Security Institution (SSI) for the reimbursement of the services. Further, we revealed that SSI payments do not meet the intensive care expenditure.

Economic implications of intra-aortic balloon support for myocardial infarction with cardiogenic shock: an analysis from the IABP-SHOCK II-trial.

The Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial has demonstrated the safety of intra-aortic balloon (IABP) support in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, but no beneficial effect on mortality. Currently, intra-aortic balloon pumping is still the most widely used support device. However, little is known about the economic implications associated with this device. Data of 600 patients included in the IABP-SHOCK II trial (registered at ClinicalTrials.gov, NCT00491036) with follow-up at 30 days, 6 and 12 months were subjected to an economic analysis. Patients with cardiogenic shock complicating AMI were randomly assigned to IABP additionally to optimal medical therapy (OMT; n = 301) or OMT alone (n = 299) before early revascularization. Costs were calculated from the perspective of a German healthcare payer. Cost-effectiveness and cost-utility analyses were performed using quality-adjusted life years (QALY) and reduction in New York Heart Association (NYHA) and Canadian Cardiac Society (CCS) class as effectiveness measures. There was a statistically significant difference in overall costs between the IABP (33,155 ± 14,593 <euro>) and the control group (32,538 ± 14,031 <euro>, p < 0.00001). This was predominantly attributed to the IABP costs in the IABP (760 ± 174 <euro>) versus control group (64 ± 218 <euro>, p < 0.0001) whilst the intensive care unit costs did not differ between the groups (29,177 ± 12,013 <euro> and 29,401 ± 12,063 <euro>, p = 0.82). There was no significant difference in QALY or NYHA and CCS reduction, respectively (p = n.s.). IABP support is associated with higher healthcare costs as compared to conservative treatment regimens. Clinically, IABP support cannot generally be recommended in AMI complicated by cardiogenic shock in the absence of a mortality benefit. However, economically considering the relatively little contribution to overall costs generated by IABP therapy it may still be considered if clinical scenarios with an IABP-induced benefit may be identified in the future.

Effectiveness of the APACHE II Scoring System in an Intensive Care Unit: Results of a Prospective Study

Background: The high cost of intensive care unit (ICU) services and limitations in health resources can prompt managers to use predictive scoring systems. Objective: To evaluate the role of APACHE II as a scoring system to predict outcomes and to compare actual and expected mortality rates. Methods: This prospective study was conducted in a10-bed, mixed ICU at Namazi University Hospital, a teaching hospital in Shiraz, Iran. All patients were included consecutively and data were collected during the first 24 h of admission. Statistical analyses were done with SPSS v.16 software. The differences were considered statistically significant at a P value of <0.05. Results: From June to November of 2013, data were available for 110 (61.4%) ICU admission. Original Research Article Mahdaviazad et al.; BJMMR, 8(12): 1018-1024, 2015; Article no.BJMMR.2015.533 1019 The patients’ mean (SD) age was 55.1 (17.7) years. Mean APACHE II score was 17.85±7.4. The total standardized mortality ratio (SMR) was 0.92, and the ratio ranged from 0.48 in medical patients to 1.22 in post-elective surgery patients. With the sensitivity 18.5% and specificity 92.8%, the highest correct classification was obtained at predicted death risk 0.6 (74.5%). Conclusion: We recommend the use of this outcome prediction score for decision-making and classifying patients based on the degree of severity of their diseases in our setting. Further work is needed with larger sample sizes to more precisely determine the generalisability of our results and evaluate validity of this outcome prediction score.

A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Patients at Private Hospital in Western India.

Pharmacoeconomics is analytical tool to know cost of hospitalization and its effect on health care system and society. In India, apart from the government health services, private sector also play big role to provide health care services. To study the direct medical cost and cost of drug therapy in hospitalized patients at private hospital. A retrospective study was conducted at private hospital in a metro city of Western India. Total 400 patients' billing records were selected randomly for a period from 01/01/2013 to 31/12/2014. Data were collected from medical record of hospital with permission of medical director of hospital. Patients' demographic profile age, sex, diagnosis and various costs like ICU charge, ventilator charge, diagnostic charge, etc. were noted in previously formed case record form. Data were analysed by Z, x(2) and unpaired t-test. Patients were divided into less than 45 years and more than 45 year age group. They were divided into medical and surgical patients according to their admission in medical or surgical ward. Mortality, Intensive Care Unit (ICU) admission, patients on ventilator were significantly (p<0.05) higher in medical patients. Direct medical cost, ward bed charge, ICU bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients while operation theatre and procedural charge were significantly (p<0.05) higher in surgical patients. Cost of fibrinolytics, anticoagulants, cardiovascular drugs were significantly (p<0.05) higher in medical patients. Cost of antimicrobials, proton pump inhibitors (PPIs), antiemetics, analgesics, were significantly (p<0.05) higher in surgical patients. Ward bed charge, ICU bed charge, ventilator charge accounted more than one third cost of direct medical cost in all the patients. Cost of drug therapy was one fourth of direct medical cost. Antimicrobials cost accounted 33% of cost of drug therapy.