title: The inverse relationship between cost and survival in the critically ill cancer patient.
abstract: The enormous cost of intensive multiple organ system support is apparent from patient or third party charges of $1500--$2000 per day exclusive of physician fees sampled during a retrospective review of 700 consecutive recent admissions to the Critical Care Facility of Memorial Cancer Center. Mortality rates of 49% for general medical, 54% for lymphoma or leukemia, and 20% for surgery patients suggest the need for a selective admission and discharge policy which concentrates financial and personnel resources on those for whom there remains a reasonable chance of worthwhile palliation, if not cure, of their malignancy. An informal policy of this kind may have contributed to a 10% increase in hospital discharges and a reduction of in-unit mortality from 22--18% when compared to 1035 earlier unselected admissions. A modified version of the classification suggested by the Critical Care Committee of the Massachusetts General Hospital has been adopted for use at this institution. A similar approach by other cancer centers is urged so that predictive indices based on prognosis of the underlying disease as well as physiological status may be developed. Otherwise, cost-benefit analysis by third party payers or government will become an unavoidable, and less satisfactory, alternative.
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics*; D005251:Fees, Medical; D005380:Financing, Government; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay; D008404:Massachusetts; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D013727:Terminal Care