title: Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system.
abstract: OBJECTIVE
  There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY).
  
  
  METHODS
  We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention).
  
  
  METHODS
  Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system.
  
  
  RESULTS
  Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1-2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50,000, cost per CPC 1-2 survivor was £65,000. Cost and length of stay of CPC 1-2 patients was considerably lower than CPC 3-4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1-2 survivor per QALY was £16,000.
  
  
  CONCLUSIONS
  The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Petrie
authors.affiliation: Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Easton
authors.affiliation: Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Naik
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Lockie
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, London, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brett
authors.affiliation: Centre for Perioperative Medicine and Critical Care Research, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Stümpfle
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D058687:Out-of-Hospital Cardiac Arrest / Q000191:economics* / Q000401:mortality / Q000628:therapy; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D016019:Survival Analysis; D006113:United Kingdom
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