Five-year survival, quality of life, and individual costs of 303 consecutive medical intensive care patients--a cost-utility analysis.
OBJECTIVE
To assess long-term survival, health-related quality of life, and associated costs 5 yrs after discharge from a medical intensive care unit.


METHODS
Prospective cohort study.


METHODS
Medical intensive care unit of a German university hospital.


METHODS
Three hundred and three consecutive patients with predominantly cardiovascular and pulmonary disorders admitted between November 1997 and February 1998 with an intensive care unit length of stay >24 hrs.


METHODS
None.


RESULTS
Demographic data, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, simplified Therapeutic Intervention Scoring System, and individual intensive care unit and hospital costs were prospectively recorded. Primary outcomes included 5-yr survival, functional status, health-related quality of life (Medical Outcome Short Form, SF-36), effective costs per survivor, and costs per life year and per quality-adjusted life year gained. Of 303 patients, 44 (14.5%) died in the hospital. Among the remaining 259 patients, 190 (73%) survived the 5-yr follow up and 173 patients (91%) completed the questionnaire. Baseline demographics including gender, age, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, simplified Therapeutic Intervention Scoring System, and admission diagnosis were similar between hospital and long-term survivors (p > .05 for all). The health status index of those patients surviving the 5-yr follow-up was 0.88, independent of patients' severity of illness. The average effective costs per survivor were 8.827 for intensive care unit costs and 14.130 for intensive care unit and hospital costs. Mean costs per life year and per quality-adjusted life year gained amounted to 19.330 and 21.922 , respectively. Increasing severity of illness was associated with higher costs.


CONCLUSIONS
Considering the severity of illness and the patients' outcome, the costs associated with both life year and quality-adjusted life year gained were within generally accepted limits for other potentially life-saving treatments.
Graf
Jürgen
J
Medical Clinic I, University Hospital Aachen, Aachen, Germany.
Wagner
Jörg
J
Graf
Carmen
C
Koch
Karl-Christian
KC
Janssens
Uwe
U
D018806:APACHE; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000191:economics* / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D040841:Resource Allocation; D018709:Statistics, Nonparametric; D015996:Survival Rate