1
|
Carrandi A, Liew C, Maiden MJ, Litton E, Taylor C, Thompson K, Higgins A. Costs of Australian intensive care: A systematic review. CRIT CARE RESUSC 2024; 26:153-158. [PMID: 39072237 PMCID: PMC11282335 DOI: 10.1016/j.ccrj.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 07/30/2024]
Abstract
Objective Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia. Design A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded. Data sources Relevant studies were sourced from a previously published review (1970-2016), a systematic search of MEDLINE and EMBASE (2016-5 May 2023), and reference checking. Review methods A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised. Results Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use. Conclusions Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.
Collapse
Affiliation(s)
- Alayna Carrandi
- Australian and New Zealand Clinical Trials Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cheelim Liew
- Eastern Health, Box Hill Hospital, Department of Intensive Care Services, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew J. Maiden
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Litton
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Colman Taylor
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Kelly Thompson
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District. Kingswood, NSW, Australia
| | - Alisa Higgins
- Australian and New Zealand Clinical Trials Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales Sydney, Sydney, Australia
| |
Collapse
|
2
|
Rui M, Wang Y, Fei Z, Zhang X, Shang Y, Li H. Will the Markov model and partitioned survival model lead to different results? A review of recent economic evidence of cancer treatments. Expert Rev Pharmacoecon Outcomes Res 2021; 21:373-380. [PMID: 33691544 DOI: 10.1080/14737167.2021.1893167] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Balancing the high cost of treatment brought about by new therapies has become a problem that needs to be considered. Cost-effectiveness analysis (CEA) is a commonly used method that provides information on the potential value of new cancer treatments. The Markov and partitioned survival (PS) models are commonly used. Whether the results differ between the models in empirical research and the methodological differences remain unclear.Areas covered: A review was conducted to identify Canadian Agency for Drugs and Technologies in Health (CADTH) reports and papers published during the past 5 years that reported full economic evaluations of cancer treatments and used both models. In the included studies, most results except one obtained using the two models did not significantly differ.Expert opinion: Not enough evidence could support that there existed relevant bias in empirical studies about the PS model, and more methodological research and application of empirical research should be performed. We recommended that when individual data are available and the model structure is not complicated, the PS model is more appropriate. Both the PS and Markov models are recommended to assess model structure uncertainty.
Collapse
Affiliation(s)
- Mingjun Rui
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Yingcheng Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Zhengyang Fei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Xueke Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Ye Shang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, People's Republic of China
| |
Collapse
|
3
|
Walsh OM, Davis K, Gatward J. Reducing inappropriate arterial blood gas testing in a level III intensive care unit: a before-and-after observational study. CRIT CARE RESUSC 2020; 22:370-377. [PMID: 38046871 PMCID: PMC10692580 DOI: 10.51893/2020.4.oa10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Arterial blood gas (ABG) analysis is the most frequently performed test in intensive care units (ICUs), often without a specific clinical indication. This is costly and contributes to iatrogenic anaemia. Objectives: To reduce the number of ABG tests performed and the proportion that are inappropriate. Design, setting and participants: The indications for ABG analysis were surveyed at a 58-bed level III ICU during fortnightly periods before and after a multifaceted educational intervention which included the introduction of a clinical guideline. The number of ABG tests performed during the period July-December 2017 was compared with that for the period July-December 2018. Tests were predefined as inappropriate if performed at regular time intervals, at change of shift, concurrently with other blood tests or after a treatment was ceased on a stable patient or after ventilatory support or oxygen delivery was decreased in an otherwise stable patient. The study was enrolled on the Quality Improvement Projects Register and ethics approval was waived by the local ethics committee. Results: There was a 31.3% bed-day adjusted decrease in number of ABG tests performed (33 005 v 22 408; P < 0.001), representing an annual saving of A$770 000 and 100 litres of blood. The proportion of inappropriate ABG tests decreased by 47.3% (54.2% v 28.6%; P < 0.001) and the number of inappropriate ABG tests per bed-day decreased by 71% (2.8 v 0.8; P < 0.001). Patient outcomes before and after the intervention did not differ (standardised mortality ratio, 0.65 v 0.63; P = 0.22). Conclusion: Staff education and implementation of a clinical guideline resulted in substantial decreases in the number of ABG tests performed and the proportion of inappropriate ABG tests.
Collapse
Affiliation(s)
- Oliver M. Walsh
- The Canberra Hospital, Canberra, ACT, Australia
- Australian National University, Canberra, ACT, Australia
| | | | - Jonathan Gatward
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
4
|
Merino-Osorio C, Velásquez M, Reveco R, Marmolejo JI, Fu C. 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country. Value Health Reg Issues 2020; 23:99-104. [PMID: 33171360 DOI: 10.1016/j.vhri.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. METHODS Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. RESULTS Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. CONCLUSIONS A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.
Collapse
Affiliation(s)
- Catalina Merino-Osorio
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
| | - Mónica Velásquez
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Medical Specialties Faculty of Medicine Universidad de La Frontera, Temuco, Chile
| | - Roberto Reveco
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Administration and Economy, Universidad de La Frontera, Temuco, Chile
| | - José Ignacio Marmolejo
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Instituto Nacional del Tórax, Santiago, Chile
| | - Carolina Fu
- Department of Physical Therapy, Speech, and Occupational Therapy, Universidade São Paulo, São Paulo, Brazil
| |
Collapse
|
5
|
Kara İ, Kara İ, Bayraktar YŞ, Çiçekci F, Yılmaz H, Duman A, Çelik JB. Bir üniversite hastanesinin yoğun bakım ünitelerinde maliyet analizi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.463401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
6
|
Continuous Mandatory Onsite Consultant Intensivists in the ICU: Impacts on Patient Outcomes. J Patient Saf 2017; 12:108-13. [PMID: 24618645 DOI: 10.1097/pts.0000000000000097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the impacts on patient outcomes of continuous versus on-demand access to certified consultant intensivists in the intensive care unit (ICU). METHODS Two general adult ICUs within the same health-care organization were compared in terms of patient outcomes. One unit featured continuous mandatory presence of a consultant intensivist (unit A), whereas the other had continuous access to a consultant intensivist during daytime hours but only on-demand access during the night-time hours (unit B). The data collected from these 2 units over the same 12-month period included sex, age, APACHE II score, disease category (medical, surgical, or traumatic), ICU mortality, and length of stay. A subgroup analysis was undertaken to assess the impact of disease severity, age, sex, and disease category on mortality. RESULTS When adjusted for disease severity, mortality was significantly lower in unit A with continuous mandatory 24-hour presence of a consultant intensivist compared with unit B with on-demand access to a consultant intensivist after working hours. Old age, female sex, and a higher APACHE II score were associated with poorer outcomes at both sites. The subgroup analysis revealed that the difference in mortality was only significant among medical patients but not among surgical or trauma patients. CONCLUSIONS An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit.
Collapse
|
7
|
Velentzis LS, Salagame U, Canfell K. Menopausal hormone therapy: a systematic review of cost-effectiveness evaluations. BMC Health Serv Res 2017; 17:326. [PMID: 28476121 PMCID: PMC5420115 DOI: 10.1186/s12913-017-2227-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/04/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Several evaluations of the cost-effectiveness (CE) of menopausal hormone therapy (MHT) have been reported. The aim of this study was to systematically and critically review economic evaluations of MHT since 2002, after the Women's Health Initiative (WHI) trial results on MHT were published. METHODS The inclusion criteria for the review were: CE analyses of MHT versus no treatment, published from 2002-2016, in healthy women, which included both symptom relief outcomes and a range of longer term health outcomes (breast cancer, coronary heart disease, stroke, fractures and colorectal cancer). Included economic models had outcomes expressed in cost per quality-adjusted life year or cost per life year saved. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases and the Cost-Effectiveness Analysis Registry were searched. CE evaluations were assessed in regard to (i) reporting standards using the CHEERS checklist and Drummond checklist; (ii) data sources for the utility of MHT with respect to menopausal symptom relief; (iii) cost derivation; (iv) outcomes considered in the models; and (v) the comprehensiveness of the models with respect to factors related to MHT use that impact long term outcomes, using breast cancer as an example outcome. RESULTS Five studies satisfying the inclusion criteria were identified which modelled cohorts of women aged 50 and older who used combination or estrogen-only MHT for 5-15 years. For women 50-60 years of age, all evaluations found MHT to be cost-effective and below the willingness-to-pay threshold of the country for which the analysis was conducted. However, 3 analyses based the quality of life (QOL) benefit for symptom relief on one small primary study. Examination of costing methods identified a need for further clarity in the methodology used to aggregate costs from sources. Using breast cancer as an example outcome, risks as measured in the WHI were used in the majority of evaluations. Apart from the type and duration of MHT use, other effect modifiers for breast cancer outcomes (for example body mass index) were not considered. CONCLUSIONS This systematic review identified issues which could impact the outcome of MHT CE analyses and the generalisability of their results. The estimated CE of MHT is driven largely by estimates of QOL improvements associated with symptom relief but data sources on these utility weights are limited. Future analyses should carefully consider data sources and the evidence on the long term risks of MHT use in terms of chronic disease. This review highlights the considerable difficulties in conducting cost-effectiveness analyses in situations where short term benefits of an intervention must be evaluated in the context of long term health outcomes.
Collapse
Affiliation(s)
- Louiza S Velentzis
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.
| | - Usha Salagame
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.,Breast and Gynaecological Cancers, Cancer Australia, Surry Hills, Sydney, NSW, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.,School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
8
|
Heydari A, Vafaee-Najar A, Bakhshi M. Intensive Care Nurses' Belief Systems Regarding the Health Economics: A Focused Ethnography. Glob J Health Sci 2016; 8:52939. [PMID: 27157164 PMCID: PMC5064092 DOI: 10.5539/gjhs.v8n9p172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/02/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Health care beliefs can have an effect on the efficiency and effectiveness of nursing practices. Nevertheless, how belief systems impact on the economic performance of intensive care unit (ICU) nurses is not known. This study aimed to explore the ICU nurses' beliefs and their effect on nurse's practices and behavior patterns regarding the health economics. METHODS In this study, a focused ethnography method was used. Twenty-four informants from ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations were used for data collection. Data analysis was performed using the methods described by Miles and Huberman (1994). FINDINGS Eight beliefs were found that gave meaning to ICU nurse's practices regarding the health economics. 1. The registration of medications and supplies disrupt the nursing care; 2.Monitoring and auditing improve consumption; 3.There is a fear of possible shortage in the future; 4.Supply and replacement of equipment is difficult; 5.Higher prices lead to more accurate consumption; 6.The quality of care precedes the costs; 7. Clinical Guidelines are abundant but useful; and 8.Patient economy has priority over hospital economy. Maintaining the quality of patient care with least attention to hospital costs was the main focus of the beliefs formed up in the ICU regarding the health economics. CONCLUSIONS ICU nurses' belief systems have significantly shaped in relation to providing a high-quality care. Although high quality of care can lead to a rise in the effectiveness of nursing care, cost control perspective should also be considered in planning for improve the quality of care. Therefore, it is necessary to involve the ICU nurses in decision-making about unit cost management. They must become familiar with the principles of heath care economics and productivity by applying an effective cost management program. It may be optimal to implement the reforms in various aspects, such as the hospital's strategic plan and supply chain management system.
Collapse
|
9
|
Azeredo-Da-Silva ALF, Perini S, Rigotti Soares PH, Polaczyk CA. Systematic Review of Economic Evaluations of Units Dedicated to Acute Coronary Syndromes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:286-295. [PMID: 27021764 DOI: 10.1016/j.jval.2015.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/14/2015] [Accepted: 11/29/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Dedicated units for the care of acute coronary syndrome (ACS) have been submitted to economic evaluations; however, the results have not been systematically presented. OBJECTIVE To identify and summarize economic outcomes of studies on hospital units dedicated to the initial care of patients with suspected or confirmed ACS. METHODS A systematic review of literature to identify economic evaluations of chest pain unit (CPU), coronary care unit (CCU), or equivalent units was done. Two search strategies were used: the first one to identify economic evaluations irrespective of study design, and the second one to identify randomized clinical trials that reported economic outcomes. The following databases were searched: MEDLINE, EMBASE, CENTRAL, and National Health Service (NHS)Economic Evaluation Database. Data extraction was performed by two independent reviewers. Costs were inflated to 2012 values. RESULTS Search strategies retrieved five partial economic evaluations based on observational studies, six randomized clinical trials that reported economic outcomes, and five model-based economic evaluations. Overall, cost estimates based on observational studies and randomized clinical trials reported statistically significant cost savings of more than 50% with the adoption of CPU care instead of routine hospitalization or CCU care for suspected low-to-intermediate risk patients with ACS (median per-patient cost US $1,969.89; range US $1,002.12-13,799.15). Model-based economic evaluations reported incremental cost-effectiveness ratios below US $ 50,000/quality-adjusted life-year for all comparisons between intermediate care unit, CPU, or CCU with routine hospital admissions. This finding was sensible to myocardial infarction probability. CONCLUSIONS Published economic evaluations indicate that more intensive care is likely to be cost-effective in comparison to routine hospital admission for patients with suspected ACS.
Collapse
Affiliation(s)
- André Luis Ferreira Azeredo-Da-Silva
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Porto Alegre Clinical Hospital, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil.
| | | | | | - Carisi Anne Polaczyk
- Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; National Institute for Health Technology Assessment (INCT/IATS-Brazil), Porto Alegre, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Cardiovascular Division of Porto Alegre Hospital, Porto Alegre, Brazil
| |
Collapse
|
10
|
Higgins AM, Harris AH. Health Economic Methods: Cost-Minimization, Cost-Effectiveness, Cost-Utility, and Cost-Benefit Evaluations. Crit Care Clin 2012; 28:11-24, v. [DOI: 10.1016/j.ccc.2011.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Lenoir-Wijnkoop I, Dapoigny M, Dubois D, van Ganse E, Gutiérrez-Ibarluzea I, Hutton J, Jones P, Mittendorf T, Poley MJ, Salminen S, Nuijten MJC. Nutrition economics - characterising the economic and health impact of nutrition. Br J Nutr 2011; 105:157-66. [PMID: 20797310 PMCID: PMC3023144 DOI: 10.1017/s0007114510003041] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 06/24/2010] [Accepted: 07/05/2010] [Indexed: 01/24/2023]
Abstract
There is a new merging of health economics and nutrition disciplines to assess the impact of diet on health and disease prevention and to characterise the health and economic aspects of specific changes in nutritional behaviour and nutrition recommendations. A rationale exists for developing the field of nutrition economics which could offer a better understanding of both nutrition, in the context of having a significant influence on health outcomes, and economics, in order to estimate the absolute and relative monetary impact of health measures. For this purpose, an expert meeting assessed questions aimed at clarifying the scope and identifying the key issues that should be taken into consideration in developing nutrition economics as a discipline that could potentially address important questions. We propose a first multidisciplinary outline for understanding the principles and particular characteristics of this emerging field. We summarise here the concepts and the observations of workshop participants and propose a basic setting for nutrition economics and health outcomes research as a novel discipline to support nutrition, health economics and health policy development in an evidence and health-benefit-based manner.
Collapse
Affiliation(s)
- I Lenoir-Wijnkoop
- Danone Research, RD 128, 91767, Scientific Affairs, Palaiseau, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Spragg RG, Bernard GR, Checkley W, Curtis JR, Gajic O, Guyatt G, Hall J, Israel E, Jain M, Needham DM, Randolph AG, Rubenfeld GD, Schoenfeld D, Thompson BT, Ware LB, Young D, Harabin AL. Beyond mortality: future clinical research in acute lung injury. Am J Respir Crit Care Med 2010; 181:1121-7. [PMID: 20224063 DOI: 10.1164/rccm.201001-0024ws] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mortality in National Heart, Lung and Blood Institute-sponsored clinical trials of treatments for acute lung injury (ALI) has decreased dramatically during the past two decades. As a consequence, design of such trials based on a mortality outcome requires ever-increasing numbers of patients. Recognizing that advances in clinical trial design might be applicable to these trials and might allow trials with fewer patients, the National Heart, Lung and Blood Institute convened a workshop of extramural experts from several disciplines. The workshop assessed the current state of clinical research addressing ALI, identified research needs, and recommended: (1) continued performance of trials evaluating treatments of patients with ALI; (2) development of strategies to perform ALI prevention trials; (3) observational studies of patients without ALI undergoing prolonged mechanical ventilation; and (4) development of a standardized format for reporting methods, endpoints, and results of ALI trials.
Collapse
Affiliation(s)
- Roger G Spragg
- Division of Lung Diseases, National Heart, Lung, and Blood Institute/ NIH, 6701 Rockledge Drive, Bethesda, MD 20892-7952, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Halvorsen K, Førde R, Nortvedt P. Professional challenges of bedside rationing in intensive care. Nurs Ethics 2009; 15:715-28. [PMID: 18849363 DOI: 10.1177/0969733008095383] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk.
Collapse
|
14
|
Brar SS, Manns BJ. Activated protein C: cost-effective or costly? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:164. [PMID: 17875223 PMCID: PMC2556732 DOI: 10.1186/cc6090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The authors offer a commentary on the study by Dhainaut et al. on the cost-effectiveness of activated protein C in severe sepsis. Using data from "real world" conditions, the results of this economic evaluation are consistent with previous analyses, and highlight the need for "real world" investigations of new health technologies in critical care.
Collapse
Affiliation(s)
- Savtaj Singh Brar
- Department of Surgery, University of Calgary and Calgary Health Region, Calgary, Alberta, T2L 2K8, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, T2L 2K8, Canada
- Department of Community Health Sciences, University of Calgary and Calgary Health Region, Calgary, Alberta, T2L 2K8, Canada
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Research priorities in critical care are increasingly focusing on long-term outcomes and prognosis for survivors of critical illness. This review will focus on long-term outcomes after acute renal failure. RECENT FINDINGS Few studies have described the long-term outcomes after acute renal failure. Rates of survival are variable and range from 46 to 74%, 55 to 73%, 57 to 65% and 65 to 70% at 90 days, 6 months, 1 year and 5 years, respectively. All of older age, co-morbid illness, illness severity, septic shock, and renal replacement therapy after cardiac surgery have been associated with reduced survival. Recovery to independence from renal replacement therapy is expected in 60-70% of survivors by 90 days. Health-related quality of life is generally good and perceived as acceptable. Survivors often experience difficulty with mobility and limitations in activities of daily living. Renal replacement therapy is costly and achieves marginal cost-effectiveness in terms of quality-adjusted survival for those with a higher probability of survival. SUMMARY The long-term survival after acute renal failure is poor. Yet, most survivors recover sufficient function to become independent from renal replacement therapy. While perceived health-related quality of life is good, survivors have a lower health-related quality of life compared with the general population. Further research is needed to explore the relationship between survival, markers of morbidity and costs after acute renal failure.
Collapse
Affiliation(s)
- Sean M Bagshaw
- Department of Intensive Care, Austin Hospital, Melbourne, Australia.
| |
Collapse
|