A cost-effectiveness analysis of stays in intensive care units.
OBJECTIVE
To evaluate patient outcome and the efficiency of stays in intensive care units (ICUs).


METHODS
Prospective study.


METHODS
Seven ICUs of teaching hospitals in the Paris area.


METHODS
Two hundred eleven stays including one in three consecutive patients admitted from September to November 1996.


RESULTS
For each patient, the following information was collected during the ICU stay: diagnosis, severity scores, organ failures, workload, cost and mortality. A cost-effectiveness ratio was computed for 176 stays with at least one organ failure, at hospital discharge and 6 months later. Quality of life was measured with EuroQol questionnaires 6 months after discharge in 64 patients representing 62 % of the patients contacted. The mean total ICU cost per stay was US$ 14,130 (+/- 6,550) (higher for non-survivors--US$ 19,060, median 10,590--than for survivors US$ 12,370, median 5,780). The incremental cost-effectiveness ratio was US$ 1,150 per life-year saved and the incremental cost-utility ratio was US$ 4,100 per quality-adjusted life-year (QALY) saved, without discounting. These results compare favourably with other health-care options. However substantial variations were observed according to age, severity, diagnosis, number of organ failures and discount rate. Intoxication had the lowest ratio (US$ 620/QALY) and acute renal insufficiency the highest (US$ 30,625/QALY).


CONCLUSIONS
This work provides medical and economic information on ICU stays in teaching hospitals and enables comparisons with other health-care options.
Sznajder
M
M
Department of Public Health and Medical Informatics, Hospital Ambroise Paré, Boulogne, France.
Aegerter
P
P
Launois
R
R
Merliere
Y
Y
Guidet
B
B
CubRea
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D015276:Health Care Rationing; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010297:Paris; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity