A systematic review of the cost-effectiveness of noncardiac transitional care units.
OBJECTIVE
To critically appraise and summarize the studies examining the cost-effectiveness of noncardiac transitional care units (TCUs).


METHODS
We conducted a computerized literature search using MEDLINE, and Current Contents from January 1, 1986 to December 31, 1995 and HealthSTAR from January 1, 1989 to December 31, 1995 with the key words intermediate care unit, respiratory care unit, and step-down unit. Bibliographies of all selected articles and review articles were examined. Personal files were also reviewed.


METHODS
(1) POPULATION: patients in a noncardiac TCU of an acute-care institution; (2) intervention: addition of a noncardiac TCU to the institution; and (3) outcomes: patient outcome-survival and associated costs.


METHODS
The necessary data were abstracted and study validity was evaluated by two independent reviewers using a modification of previously published criteria.


RESULTS
The studies were summarized qualitatively; upon inspection, they were too heterogeneous to allow quantitative analysis. While the studies all claimed that their TCUs were cost-effective, the economic evaluation designs were flawed to such an extent that the validity of the conclusions is suspect.


CONCLUSIONS
To date, the evidence in the literature is insufficient to determine under which circumstances, if any, TCUs are a cost-effective alternative technology to the traditional institution with only ICU and general ward beds.
Keenan
S P
SP
Richard Ivey Critical Care Trauma Center, Victoria Campus, University of Western Ontario, London, Canada.
Massel
D
D
Inman
K J
KJ
Sibbald
W J
WJ
D006801:Humans; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D017048:Health Care Costs; D006302:Health Services Research / Q000379:methods; D007380:Intermediate Care Facilities / Q000191:economics / Q000706:statistics & numerical data; D016239:MEDLINE; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014481:United States