Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study
OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use...
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| Veröffentlicht in: | Critical care medicine 2020-05, Vol.48 (5), p.e345-e355 |
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| creator | Jukarainen, Sakari Mildh, Henriikka Pettilä, Ville Häkkinen, Unto Peltola, Mikko Ala-Kokko, Tero Reinikainen, Matti Vaara, Suvi T. |
| description | OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.
DESIGN:Prospective observational study.
SETTING:Seventeen ICUs providing critical care to 85% of the Finnish adult population.
PATIENTS:Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).
CONCLUSIONS:Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value. |
| doi_str_mv | 10.1097/CCM.0000000000004210 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1097_CCM_0000000000004210</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>31929342</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3680-785ff74853b39d355ecd793cac5279cb753fb34b0f91fccae5a07998aacd29173</originalsourceid><addsrcrecordid>eNqFkF1LwzAUhoMobk7_gUj-QOfJ19J4N4o6YUNh7rqkacKq3YdN6ti_N9tUxAsNhJxwnveQPAhdEugTUPI6yyZ9-LE4JXCEukQwSIAqdoy6AAoSxhXroDPvXwAIF5Kdog4jKhKcdpHJVj54rJcl3lXJLFR1FbZ45XDWVKEyusaZbuyemLaFt2-tXQY8sroO833rBg_xpK0jGxu2wU_Nyq-tCdW7xdPQlttzdOJ07e3F59lDs7vb52yUjB_vH7LhODFskEIiU-Gc5KlgBVMlE8KaUipmtBFUKlNIwVzBeAFOEWeMtkKDVCrV2pRUEcl6iB_mmvgC31iXr5tqoZttTiDfOcujs_y3sxi7OsTWbbGw5XfoS1IE0gOwWdXxg_61bje2yed7Bf_N5n9EdxijfJBQoAAi3pK4aco-ALSth-g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Jukarainen, Sakari ; Mildh, Henriikka ; Pettilä, Ville ; Häkkinen, Unto ; Peltola, Mikko ; Ala-Kokko, Tero ; Reinikainen, Matti ; Vaara, Suvi T.</creator><creatorcontrib>Jukarainen, Sakari ; Mildh, Henriikka ; Pettilä, Ville ; Häkkinen, Unto ; Peltola, Mikko ; Ala-Kokko, Tero ; Reinikainen, Matti ; Vaara, Suvi T.</creatorcontrib><description>OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.
DESIGN:Prospective observational study.
SETTING:Seventeen ICUs providing critical care to 85% of the Finnish adult population.
PATIENTS:Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).
CONCLUSIONS:Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000004210</identifier><identifier>PMID: 31929342</identifier><language>eng</language><publisher>United States: by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Aged ; Aged, 80 and over ; APACHE ; Cost-Benefit Analysis ; Critical Care - economics ; Female ; Finland - epidemiology ; Health Expenditures - statistics & numerical data ; Health Resources - economics ; Health Resources - statistics & numerical data ; Health Services - economics ; Health Services - statistics & numerical data ; Humans ; Male ; Middle Aged ; Models, Econometric ; Patient Acceptance of Health Care - statistics & numerical data ; Patient Readmission ; Prospective Studies ; Quality-Adjusted Life Years ; Survivors - statistics & numerical data</subject><ispartof>Critical care medicine, 2020-05, Vol.48 (5), p.e345-e355</ispartof><rights>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3680-785ff74853b39d355ecd793cac5279cb753fb34b0f91fccae5a07998aacd29173</citedby><cites>FETCH-LOGICAL-c3680-785ff74853b39d355ecd793cac5279cb753fb34b0f91fccae5a07998aacd29173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31929342$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jukarainen, Sakari</creatorcontrib><creatorcontrib>Mildh, Henriikka</creatorcontrib><creatorcontrib>Pettilä, Ville</creatorcontrib><creatorcontrib>Häkkinen, Unto</creatorcontrib><creatorcontrib>Peltola, Mikko</creatorcontrib><creatorcontrib>Ala-Kokko, Tero</creatorcontrib><creatorcontrib>Reinikainen, Matti</creatorcontrib><creatorcontrib>Vaara, Suvi T.</creatorcontrib><title>Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.
DESIGN:Prospective observational study.
SETTING:Seventeen ICUs providing critical care to 85% of the Finnish adult population.
PATIENTS:Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).
CONCLUSIONS:Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>APACHE</subject><subject>Cost-Benefit Analysis</subject><subject>Critical Care - economics</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Health Resources - economics</subject><subject>Health Resources - statistics & numerical data</subject><subject>Health Services - economics</subject><subject>Health Services - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Econometric</subject><subject>Patient Acceptance of Health Care - statistics & numerical data</subject><subject>Patient Readmission</subject><subject>Prospective Studies</subject><subject>Quality-Adjusted Life Years</subject><subject>Survivors - statistics & numerical data</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkF1LwzAUhoMobk7_gUj-QOfJ19J4N4o6YUNh7rqkacKq3YdN6ti_N9tUxAsNhJxwnveQPAhdEugTUPI6yyZ9-LE4JXCEukQwSIAqdoy6AAoSxhXroDPvXwAIF5Kdog4jKhKcdpHJVj54rJcl3lXJLFR1FbZ45XDWVKEyusaZbuyemLaFt2-tXQY8sroO833rBg_xpK0jGxu2wU_Nyq-tCdW7xdPQlttzdOJ07e3F59lDs7vb52yUjB_vH7LhODFskEIiU-Gc5KlgBVMlE8KaUipmtBFUKlNIwVzBeAFOEWeMtkKDVCrV2pRUEcl6iB_mmvgC31iXr5tqoZttTiDfOcujs_y3sxi7OsTWbbGw5XfoS1IE0gOwWdXxg_61bje2yed7Bf_N5n9EdxijfJBQoAAi3pK4aco-ALSth-g</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Jukarainen, Sakari</creator><creator>Mildh, Henriikka</creator><creator>Pettilä, Ville</creator><creator>Häkkinen, Unto</creator><creator>Peltola, Mikko</creator><creator>Ala-Kokko, Tero</creator><creator>Reinikainen, Matti</creator><creator>Vaara, Suvi T.</creator><general>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20200501</creationdate><title>Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study</title><author>Jukarainen, Sakari ; Mildh, Henriikka ; Pettilä, Ville ; Häkkinen, Unto ; Peltola, Mikko ; Ala-Kokko, Tero ; Reinikainen, Matti ; Vaara, Suvi T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3680-785ff74853b39d355ecd793cac5279cb753fb34b0f91fccae5a07998aacd29173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>APACHE</topic><topic>Cost-Benefit Analysis</topic><topic>Critical Care - economics</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Health Resources - economics</topic><topic>Health Resources - statistics & numerical data</topic><topic>Health Services - economics</topic><topic>Health Services - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Econometric</topic><topic>Patient Acceptance of Health Care - statistics & numerical data</topic><topic>Patient Readmission</topic><topic>Prospective Studies</topic><topic>Quality-Adjusted Life Years</topic><topic>Survivors - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jukarainen, Sakari</creatorcontrib><creatorcontrib>Mildh, Henriikka</creatorcontrib><creatorcontrib>Pettilä, Ville</creatorcontrib><creatorcontrib>Häkkinen, Unto</creatorcontrib><creatorcontrib>Peltola, Mikko</creatorcontrib><creatorcontrib>Ala-Kokko, Tero</creatorcontrib><creatorcontrib>Reinikainen, Matti</creatorcontrib><creatorcontrib>Vaara, Suvi T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jukarainen, Sakari</au><au>Mildh, Henriikka</au><au>Pettilä, Ville</au><au>Häkkinen, Unto</au><au>Peltola, Mikko</au><au>Ala-Kokko, Tero</au><au>Reinikainen, Matti</au><au>Vaara, Suvi T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>48</volume><issue>5</issue><spage>e345</spage><epage>e355</epage><pages>e345-e355</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract>OBJECTIVES:The number of critical care survivors is growing, but their long-term outcomes and resource use are poorly characterized. Estimating the cost-utility of critical care is necessary to ensure reasonable use of resources. The objective of this study was to analyze the long-term resource use and costs, and to estimate the cost-utility, of critical care.
DESIGN:Prospective observational study.
SETTING:Seventeen ICUs providing critical care to 85% of the Finnish adult population.
PATIENTS:Adult patients admitted to any of 17 Finnish ICUs from September 2011 to February 2012, enrolled in the Finnish Acute Kidney Injury (FINNAKI) study, and matched hospitalized controls from the same time period.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We primarily assessed total 3-year healthcare costs per quality-adjusted life-years at 3 years. We also estimated predicted life-time quality-adjusted life-years and described resource use and costs. The costing year was 2016. Of 2,869 patients, 1,839 (64.1%) survived the 3-year follow-up period. During the first year, 1,290 of 2,212 (58.3%) index episode survivors were rehospitalized. Median (interquartile range) 3-year cumulative costs per patient were $49,200 ($30,000–$85,700). ICU costs constituted 21.4% of the total costs during the 3-year follow-up. Compared with matched hospital controls, costs of the critically ill remained higher throughout the follow-up. Estimated total mean (95% CI) 3-year costs per 3-year quality-adjusted life-years were $46,000 ($44,700–$48,500) and per predicted life-time quality-adjusted life-years $8,460 ($8,060–8,870). Three-year costs per 3-year quality-adjusted life-years were $61,100 ($57,900–$64,400) for those with an estimated risk of in-hospital death exceeding 15% (based on the Simplified Acute Physiology Score II).
CONCLUSIONS:Healthcare resource use was substantial after critical care and remained higher compared with matched hospital controls. Estimated cost-utility of critical care in Finland was of high value.</abstract><cop>United States</cop><pub>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>31929342</pmid><doi>10.1097/CCM.0000000000004210</doi></addata></record> |
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| ispartof | Critical care medicine, 2020-05, Vol.48 (5), p.e345-e355 |
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| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Aged Aged, 80 and over APACHE Cost-Benefit Analysis Critical Care - economics Female Finland - epidemiology Health Expenditures - statistics & numerical data Health Resources - economics Health Resources - statistics & numerical data Health Services - economics Health Services - statistics & numerical data Humans Male Middle Aged Models, Econometric Patient Acceptance of Health Care - statistics & numerical data Patient Readmission Prospective Studies Quality-Adjusted Life Years Survivors - statistics & numerical data |
| title | Costs and Cost-Utility of Critical Care and Subsequent Health Care: A Multicenter Prospective Study |
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