Is It `Worthwhile' To Continue Treating Patients With a Prolonged Stay (>14 Days) in the ICU?

An Economic Evaluation

¹ From the Department of Medicine, Queen's University, Kingston, Ontario
² From the Department of Adult Intensive Care, Royal Alexandra Hospital and the Division of Critical Care Medicine, University of Alberta Hospitals, Edmonton, Alberta
³ From the Center for Health Economics and Policy Analysis and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario

Objective: To compare the cost and consequences of a policy of continuing to care for patients with a prolonged stay in the ICU with a proposed policy of withdrawing support.

Design: Economic evaluation using data derived from a prospective cohort study.

Setting: Adult medical/surgical ICU in a tertiary care hospital.

Patients: Consecutive patients admitted to the ICU.

Intervention: None.

Main outcome measures: We performed a cost-accounting analysis on each patient in the ICU and followed up patients until 12 months after admission to ICU and assessed components of quality of life in survivors.

Results: During the study period, 690 patients were admitted to the ICU. Only 61 (9%) patients remained in the ICU for >14 days. For this group, the mean length of stay in the ICU was 24.5 (±11.7) days and duration in hospital was 57.9 (±56.9) days. At 12 months, 27 (44%) were alive. Overall, the mean quality of life score at 12 months did not differ between patients with a short or prolonged stay in the ICU. The average ICU cost per day per patient was $1,565 (Canadian) resulting in a total cost for the whole cohort of Can $1,917,382. Over the same time period, 58 patients had life support withdrawn. On average, patients survived another day in the ICU, 2 more days in hospital, and all patients ultimately died. When treatment was discontinued, the costs of treating this cohort was Can $156,465. The incremental cost-effectiveness ratio is Can $65,219 per life saved or Can $4,350 per life-year saved.

Conclusions: A considerable proportion of patients with a prolonged length of stay in the ICU survive their critical illness. Furthermore, their long-term quality of life seems reasonable. Our data suggest that continuing treatment for patients with a prolonged ICU stay may represent an efficient use of hospital resources and should be considered in the context of local budgets.

Key Words: cost analysis • critical care or intensive care • economic evaluations • health status measurements • quality of life

Submitted on August 12, 1997
Accepted on December 3, 1997

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