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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Critical Care 1/2018

Costs, outcome and cost-effectiveness of neurocritical care: a multi-center observational study

Zeitschrift:
Critical Care > Ausgabe 1/2018
Autoren:
R. Raj, S. Bendel, M. Reinikainen, S. Hoppu, R. Laitio, T. Ala-Kokko, S. Curtze, M. B. Skrifvars
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13054-018-2151-5) contains supplementary material, which is available to authorized users.

Abstract

Background

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).

Methods

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.

Results

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).

Conclusion

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.
Zusatzmaterial
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
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