Semin Respir Crit Care Med 2010; 31(1): 013-018
DOI: 10.1055/s-0029-1246282
© Thieme Medical Publishers

Understanding Cost-Effectiveness in the ICU

Marya D. Zilberberg1 , 2
  • 1School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
  • 2EviMed Research Group, LLC, Goshen, Massachusetts
Further Information

Publication History

Publication Date:
25 January 2010 (online)

ABSTRACT

Health care delivery in the United States and abroad has undergone tremendous growth over the last several decades. Accompanying this growth in the diagnostic and therapeutic armamentarium, the costs of health care have escalated out of proportion to the rest of the economy. This exuberant growth has engendered careful scrutiny of the practice of medicine with regard to both its effectiveness and its efficiency. The intensive care unit (ICU) has not been exempt from the quest for increased efficiency of health care delivery. This movement demands that physicians understand not only the effectiveness but also the cost of their interventions. Cost-effectiveness and cost-utility analyses have become critical evaluative tools in medicine. Explicit articulation of comparative cost-effectiveness is helpful in making choices about allocating limited resources in the setting of increasing competition for these resources. This article provides a primer for understanding the methods and applications of cost-effectiveness and cost-utility analyses in the ICU.

REFERENCES

  • 1 Epstein S K. Etiology of extubation failure and the predictive value of the rapid shallow breathing index.  Am J Respir Crit Care Med. 1995;  152(2) 545-549
  • 2 Esteban A, Frutos F, Tobin M J Spanish Lung Failure Collaborative Group et al. A comparison of four methods of weaning patients from mechanical ventilation.  N Engl J Med. 1995;  332 345-350
  • 3 Ely E W, Baker A M, Dunagan D P et al.. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously.  N Engl J Med. 1996;  335 1864-1869
  • 4 Kollef M H, Shapiro S D, Silver P et al.. A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation.  Crit Care Med. 1997;  25 567-574
  • 5 Kress J P, Pohlman A S, O'Connor M F, Hall J B. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.  N Engl J Med. 2000;  342 1471-1477
  • 6 Stewart T E, Meade M O, Cook D J Pressure- and Volume-Limited Ventilation Strategy Group et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome.  N Engl J Med. 1998;  338 355-361
  • 7 Rivers E, Nguyen B, Havstad S Early Goal-Directed Therapy Collaborative Group et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 1368-1377
  • 8 Annane D, Sébille V, Charpentier C et al.. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock.  JAMA. 2002;  288 862-871
  • 9 van den Berghe G, Wouters P, Weekers F et al.. Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
  • 10 Connors Jr A F, Speroff T, Dawson N V SUPPORT Investigators et al. The effectiveness of right heart catheterization in the initial care of critically ill patients.  JAMA. 1996;  276 889-897
  • 11 Hébert P C, Wells G, Blajchman M A et al.. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group.  N Engl J Med. 1999;  340 409-417
  • 12 Institute of Medicine .To Err Is Human: Building a Safer Health System. Washington, DC; National Academy Press 1999
  • 13 McGlynn E A, Asch S M, Adams J et al.. The quality of health care delivered to adults in the United States.  N Engl J Med. 2003;  348 2635-2645
  • 14 OECD health data 2009—frequently requested data. Available at: http://www.oecd.org/dataoecd/48/4/33727936.pdf Accessed November 27, 2006
  • 15 Schwartz K, Vilquin J T. Building the translational highway: toward new partnerships between academia and the private sector.  Nat Med. 2003;  9 493-495
  • 16 Martin G S, Mannino D M, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000.  N Engl J Med. 2003;  348 1546-1554
  • 17 Dombrovskiy V Y, Martin A A, Sunderram J, Paz H L. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations.  Crit Care Med. 2005;  33 2555-2562
  • 18 Dombrovskiy V Y, Martin A A, Sunderram J, Paz H L. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003.  Crit Care Med. 2007;  35 1244-1250
  • 19 Zilberberg M D, de Wit M, Pirone J R, Shorr A F. Growth in adult prolonged acute mechanical ventilation: implications for healthcare delivery.  Crit Care Med. 2008;  36 1451-1455
  • 20 Chelluri L, Im K A, Belle S H et al.. Long-term mortality and quality of life after prolonged mechanical ventilation.  Crit Care Med. 2004;  32 61-69
  • 21 Angus D C, Clermont G, Linde-Zwirble W T NO-06 Investigators et al. Healthcare costs and long-term outcomes after acute respiratory distress syndrome: a phase III trial of inhaled nitric oxide.  Crit Care Med. 2006;  34 2883-2890
  • 22 Hopkins R O, Jackson J C. Long-term neurocognitive function after critical illness.  Chest. 2006;  130 869-878
  • 23 Hopkins R O, Weaver L K, Collingridge D, Parkinson R B, Chan K J, Orme Jr J F. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2005;  171 340-347
  • 24 Van Pelt D C, Milbrandt E B, Qin L et al.. Informal caregiver burden among survivors of prolonged mechanical ventilation.  Am J Respir Crit Care Med. 2007;  175 167-173
  • 25 Halpern N A, Pastores S M, Greenstein R J. Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs.  Crit Care Med. 2004;  32 1254-1259
  • 26 Understanding costs and cost-effectiveness in critical care: report from the second American Thoracic Society workshop on outcomes research.  Am J Respir Crit Care Med. 2002;  165 540-550
  • 27 Weinstein M C, Siegel J E, Gold M R, Kamlet M S, Russell L B. Recommendations of the panel on cost-effectiveness in health and medicine.  JAMA. 1996;  276 1253-1258
  • 28 Angus D C, Linde-Zwirble W T, Clermont G PROWESS Investigators et al. Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis.  Crit Care Med. 2003;  31 1-11
  • 29 Shorr A F, Susla G M, Kollef M H. Linezolid for treatment of ventilator-associated pneumonia: a cost-effective alternative to vancomycin.  Crit Care Med. 2004;  32 137-143
  • 30 Shorr A F, Zilberberg M D, Kollef M H. Cost-effectiveness analysis of a silver-coated endotracheal tube to reduce the incidence of ventilator-associated pneumonia.  Infect Control Hosp Epidemiol. 2009;  30 759-763
  • 31 Zilberberg M D, Kothari S, Shorr A F. Cost-effectiveness of micafungin as an alternative to fluconazole empiric treatment of suspected ICU-acquired candidemia among patients with sepsis: a model simulation.  Crit Care. 2009;  13 R94
  • 32 Talmor D, Shapiro N, Greenberg D, Stone P W, Neumann P J. When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature.  Crit Care Med. 2006;  34 2738-2747
  • 33 Price K F. Pricing Medicare's diagnosis-related groups: charges versus estimated costs. Health Care Financing Review, Fall 1989. Available at: http://findarticles.com/p/articles/mi_m0795/is_n1_v11/ai_9338473 Accessed September 18, 2009
  • 34 Warren D K, Shukla S J, Olsen M A et al.. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center.  Crit Care Med. 2003;  31 1312-1317
  • 35 Dasta J F, McLaughlin T P, Mody S H, Piech C T. Daily cost of an intensive care unit day: the contribution of mechanical ventilation.  Crit Care Med. 2005;  33 1266-1271
  • 36 Kahn J M, Rubenfeld G D, Rohrbach J, Fuchs B D. Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients.  Med Care. 2008;  46 1226-1233
  • 37 Huang D T, Clermont G, Dremsizov T T, Angus D C. ProCESS Investigators . Implementation of early goal-directed therapy for severe sepsis and septic shock: a decision analysis.  Crit Care Med. 2007;  35 2090-2100
  • 38 Pronovost P J, Needham D M, Waters H et al.. Intensive care unit physician staffing: financial modeling of the Leapfrog standard.  Crit Care Med. 2004;  32 1247-1253
  • 39 Kahn J M, Kramer A A, Rubenfeld G D. Transferring critically ill patients out of hospital improves the standardized mortality ratio: a simulation study.  Chest. 2007;  131 68-75

Marya D ZilberbergM.D. M.P.H. 

EviMed Research Group

LLC, P.O. Box 303, Goshen, MA 01032

Email: Marya@EviMedGroup.org

    >