The online version of this article (https://doi.org/10.1186/s13054-018-2151-5) contains supplementary material, which is available to authorized users.
Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU).
We used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003–2013. Outcome variables were one-year mortality and permanent disability. Total healthcare costs included the index university hospital costs, rehabilitation hospital costs and social security costs up to one year. All costs were converted to euros based on the 2013 currency rate.
In total 7044 patients were included (44% with TBI, 13% with ICH, 27% with SAH, 16% with AIS). In comparison to TBI, ICH was associated with the highest risk of death and permanent disability (OR 2.6, 95% CI 2.1–3.2 and OR 1.7, 95% CI 1.4–2.1), followed by AIS (OR 1.9, 95% CI 1.5–2.3 and OR 1.5, 95% CI 1.3–1.8) and SAH (OR 1.8, 95% CI 1.5–2.1 and OR 0.8, 95% CI 0.6–0.9), after adjusting for severity of illness. SAH was associated with the highest mean total costs (€51,906) followed by ICH (€47,661), TBI (€43,916) and AIS (€39,222). Cost per independent survivor was lower for TBI (€58,497) and SAH (€96,369) compared to AIS (€104,374) and ICH (€178,071).
Neurocritical illnesses are costly and resource-demanding diseases associated with poor outcomes. Intensive care of patients with TBI or SAH more commonly result in independent survivors and is associated with lower total treatments costs compared to ICH and AIS.
Additional file 1: The STROBE guidelines. (DOC 84 kb)13054_2018_2151_MOESM1_ESM.doc
Additional file 2: Changes in probability of one-year mortality (with 95% confidence intervals), reflecting severity of illness, for the diagnostic groups. The y-axis scale extends from 0 to 0.8, where 0 indicates that the probability is 0% and 0.8 that the probability is 80%. Probabilities were calculated by logistic regression analysis adjusting for age, GCS score, chronic comorbidity, pre-admission functional status and SAPS 2, separately for the diagnostic groups. A trend towards lower severity of illness was noted in all diagnostic groups. A small reduction in severity of illness was noted for patients with traumatic brain injury and subarachnoid hemorrhage. Between 2007 and 2009, severity of illness dropped notably in patients with acute ischemic stroke and intracerebral hemorrhage. (TIF 323 kb)13054_2018_2151_MOESM2_ESM.tif
Additional file 3: Temporal change in risk bands within the diagnostic groups. Patients were divided into 4 equally sized risk bands within their own diagnostic group according to risk of one-year mortality (severity of illness). The relative proportion of patients in risk bands 1 and 2 increased with time in all diagnostic groups. The increase was most notable among patients with ICH and AIS, indicating that more patients with less severe illness were admitted towards the end of the study period. (TIF 544 kb)13054_2018_2151_MOESM3_ESM.tif
Additional file 4: Changes in the sum of costs and absolute number of patients during the study period by diagnostic group. The bars (blue) represent the sum of costs for all patients in the particular diagnostic group treated during that particular year. The connected boxes indicate the absolute number of patients in the particular diagnostic group treated during that particular year. The absolute number of patients treated in the intensive care unit increased in all diagnostic groups. Accordingly, the sum of costs increased. (TIF 3003 kb)13054_2018_2151_MOESM4_ESM.tif
Additional file 5: Changes in mean cost per patient (with 95% confidence intervals) during the study period for the diagnostic groups. A trend towards lower mean cost per patient was noted in the traumatic brain injury, intracerebral hemorrhage and acute ischemic stroke groups, while mean cost per patient remained largely the same for patients in the subarachnoid hemorrhage group. (TIF 1051 kb)13054_2018_2151_MOESM5_ESM.tif
Additional file 6: Effective cost per survivor (ECPS) and effective cost per independent survivor (ECPIS) according to diagnostic group and risk band. Risk band 1 (upper left) represents patients with one-year mortality risk of 0–25%, risk band 2 (upper right) represents patients with one-year mortality risk of 26–50%, risk band 3 (lower left) represents patients with one-year mortality risk of 51–75%, and risk band 4 represent patients with one-year mortality risk of 76–100%. The risk bands were created separately for all diagnostic groups by adjusting for age, GCS score, pre-admission functional status, significant chronic comorbidity and the modified SAPS II score. (TIF 931 kb)13054_2018_2151_MOESM6_ESM.tif
Majdan M, Plancikova D, Maas A, Polinder S, Feigin V, Theadom A, et al. Years of life lost due to traumatic brain injury in Europe: a cross-sectional analysis of 16 countries. PLoS Med. 2017;14:e1002331. Schreiber M, editor. Public Library of Science. Available from: http://dx.plos.org/10.1371/journal.pmed.1002331. Cited 10 Sep 2017 CrossRef
Majdan M, Plancikova D, Brazinova A, Rusnak M, Nieboer D, Feigin V, et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016;1:e76–83. Available from: http://linkinghub.elsevier.com/retrieve/pii/S2468266716300172. Cited 4 Mar 2017 CrossRef
GBD 2015 Neurological Disorders Collaborator Group VL, Abajobir AA, Abate KH, Abd-Allah F, Abdulle AM, Abera SF, et al. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16:877–97. Elsevier. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28931491. Cited 27 Jan 2018 CrossRef
Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15:913–24. Elsevier. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27291521. Cited 27 Jan 2018 CrossRef
Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38:65–71. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19730257. Cited 10 Mar 2017 CrossRef
Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med. 2004;32:1254–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15187502. Cited 10 Mar 2017 CrossRef
Halpern NA, Goldman DA, Tan KS, Pastores SM. Trends in critical care beds and use among population groups and Medicare and Medicaid beneficiaries in the United States. Crit Care Med. 2016;44:1490–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27136721. Cited 31 May 31 CrossRef
Reinikainen M, Uusaro A, Niskanen M, Ruokonen E. Intensive care of the elderly in Finland. Acta Anaesthesiol Scand. 2007;51:522–9. CrossRef
Reinikainen M, Mussalo P, Hovilehto S, Uusaro A, Varpula T, Kari A, et al. Association of automated data collection and data completeness with outcomes of intensive care. A new customised model for outcome prediction. Acta Anaesthesiol Scand. 2012;56:1114–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22384799. Cited 12 Sep 12 CrossRef
Keene AR, Cullen DJ. Therapeutic intervention scoring system: update 1983. Crit Care Med. 1983;11:1–3. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=6848305 CrossRef
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med. 1985;13:818–29. CrossRef
Le Gall J-R, Lemeshow S, Saulnier F. Simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63. CrossRef
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8844239. Cited 12 Sep 2017 CrossRef
Raj R, Bendel S, Reinikainen M, Hoppu S, Luoto T, Ala-Kokko T, et al. Temporal trends in healthcare costs and outcome following ICU admission after traumatic brain injury. Crit Care Med [internet]. 2018;1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29293155. Cited 26 Jan 2018
Kapiainen S, Väisänen A, Haula T, Raportti R. Terveyden-ja sosiaalihuollon yksikkökustannukset Suomessa vuonna 2011 [Internet]. 2014. Available from: http://www.julkari.fi/bitstream/handle/10024/114683/THL_RAPO3_2014_web.pdf?sequence=1. Accessed 1 Jan 2017.
Raj R, Skrifvars M, Bendel S, Selander T, Kivisaari R, Siironen J, Reinikainen M. Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores. Crit Care. 2014;18(2):R60 URL: https://www.ncbi.nlm.nih.gov/pubmed/24708781. CrossRef
Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Raj R. Common intensive care scoring systems do not outperform age and Glasgow coma scale score in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage treated in the intensive care unit. Scand J Trauma Resusc Emerg Med. 2017;25(1):102. https://doi.org/10.1186/s13049-017-0448-z.
Reynolds HN, Haupt MT, Thill-Baharozian MC, Carlson RW. Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA. 1988;260:3446–50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3210284. Cited 10 Mar 2017 CrossRef
Fernando SM, Reardon PM, Dowlatshahi D, English SW, Thavorn K, Tanuseputro P, et al. Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage. Crit Care Med [Internet]. 2018;1. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29406421. Cited 11 Feb 2018
Wilby MJ, Sharp M, Whitfield PC, Hutchinson PJ, Menon DK, Kirkpatrick PJ. Cost-effective outcome for treating poor-grade subarachnoid hemorrhage. Stroke. 2003;34:2508–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12958321. Cited 5 Feb 2018 CrossRef
Maud A, Lakshminarayan K, MFK S, Vazquez G, Lanzino G, Qureshi AI. Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg. 2009;110:880–6. American Association of Neurological Surgeons. Available from: http://thejns.org/doi/10.3171/2008.8.JNS0858. Cited 27 Mar 2018 CrossRef
Chen A, Bushmeneva K, Zagorski B, Colantonio A, Parsons D, Wodchis WP. Direct cost associated with acquired brain injury in Ontario. BMC Neurol. 2012;12:76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22901094. Cited 4 Mar 2017 CrossRef
Te Ao B, Brown P, Tobias M, Ameratunga S, Barker-Collo S, Theadom A, et al. Cost of traumatic brain injury in New Zealand: evidence from a population-based study. Neurology. 2014;83(18):1645–52. https://doi.org/10.1212/WNL.0000000000000933. CrossRef
Davis KL, Joshi AV, Tortella BJ, Candrilli SD. The direct economic burden of blunt and penetrating trauma in a managed care population. J Trauma. 2007;62:622–30. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17414338. Cited 13 Mar 2017 CrossRef
Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke [internet]. 2015; Available from: http://stroke.ahajournals.org/content/early/2015/05/28/STR.0000000000000069. Cited 12 Sept 2017
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306. Massachusetts Medical Society. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1503780. Cited 13 Feb 2018 CrossRef
Saver JL, Goyal M, Bonafe A, Diener H-C, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95. Massachusetts Medical Society. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1415061. Cited 13 Feb 2018 CrossRef
Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18. Massachusetts Medical Society. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1414792. Cited 13 Feb 2018 CrossRef
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30. Massachusetts Medical Society. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1414905. Cited 13 Feb 2018 CrossRef
Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, yoo a, et al. a randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25517348. Cited 13 Feb 2018 CrossRef
Shireman TI, Wang K, Saver JL, Goyal M, Bonafé A, Diener H-C, et al. Cost-effectiveness of Solitaire stent retriever thrombectomy for acute ischemic stroke. Stroke. 2017;48:379–87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28028150. Cited 13 Feb 2018 CrossRef
Achit H, Soudant M, Hosseini K, Bannay A, Epstein J, Bracard S, et al. Cost-effectiveness of thrombectomy in patients with acute ischemic stroke. Stroke. 2017;48:2843–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28916667. Cited 13 Feb 2018 CrossRef
Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP. The variability of critical care bed numbers in Europe. Intensive Care Med. 2012;38:1647–53. Springer-Verlag. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22777516. Cited 17 Mar 2018 CrossRef
Carr BG, Addyson DK, Kahn JM. Variation in critical care beds per capita in the United States: implications for pandemic and disaster planning. JAMA. 2010;303:1371. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20388892. Cited 17 Mar 2018 CrossRef
Korja M, Lehto H, Juvela S, Kaprio J. Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates. Neurology. 2016;87:1118–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27521438. Cited 11 Feb 2017 CrossRef
- Costs, outcome and cost-effectiveness of neurocritical care: a multi-center observational study
M. B. Skrifvars
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II