Cost-Effectiveness Studies in the ICU: A Systematic Review*

Abstract

Objectives: Cost-effectiveness analyses are increasingly used to aid decisions about resource allocation in healthcare; this practice is slow to translate into critical care. We sought to identify and summarize original cost-effectiveness studies presenting cost per quality-adjusted life year, incremental cost-effectiveness ratios, or cost per life-year ratios for treatments used in ICUs. Design: We conducted a systematic search of the English-language literature for cost-effectiveness analyses published from 1993 to 2018 in critical care. Study quality was assessed using the Drummond checklist. Setting: Critical care units. Patients or Subjects: Critical care patients. Interventions: Identified studies with cost-effectiveness analyses. Measurements and Main Results: We identified 97 studies published through 2018 with 156 cost-effectiveness ratios. Reported incremental cost-effectiveness ratios ranged from –$119,635 (hypothetical cohort of patients requiring either intermittent or continuous renal replacement therapy) to $876,539 (data from an acute renal failure study in which continuous renal replacement therapy was the most expensive therapy). Many studies reported favorable cost-effectiveness profiles (i.e., below $50,000 per life year or quality-adjusted life year). However, several therapies have since been proven harmful. Over 2 decades, relatively few cost-effectiveness studies in critical care have been published (average 4.6 studies per year). There has been a more recent trend toward using hypothetical cohorts and modeling scenarios without proven clinical data (2014–2018: 19/33 [58%]). Conclusions: Despite critical care being a significant healthcare cost burden there remains a paucity of studies in the literature evaluating its cost effectiveness.

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

“…Wilcox and colleagues recently summarised economic evaluations of interventions in critical care and despite searching the literature from 1993 to 2018, identified just 20 evaluations of sepsis interventions, compared to 46 evaluations of sepsis interventions in the current review [14]. Our review differs from that of Wilcox and colleagues in that we did not restrict our search by year of publication, language, or location of critically ill patients (Wilcox and colleagues limited their review to the ICU setting).…”

“…Since that time, numerous other interventions for the treatment of sepsis have been evaluated. Wilcox and colleagues recently published a systematic review of the cost effectiveness literature in critical care medicine; however, their review was limited to intensive care interventions and English language publications [14]. Given the global burden of sepsis, we conducted a contemporary systematic review of economic evaluations of interventions for sepsis management in critically ill adult patients, including interventions delivered outside of the intensive care setting (such as in the emergency department) and articles published in languages other than English.…”

Economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): study protocol

“…The literature currently has a paucity of health economic evaluations, illustrating the importance of E-PROSPECT. 40 strengths and limitations Some aspects of our methodology have potential limitations. First, the time horizon is relatively short, with no outpatient follow-up (only reporting in-hospital outcomes).…”

How to allocate intensive care resources during the COVID-19 pandemic: medical triage or a priori selection?

“…It has been reported that ICUs reduce the mortality rate in a cost-effective manner, and cost-effectiveness analyses are a strong argument in resource allocation for intensive care medicine ( 8 ). Nevertheless, a relatively new publication concluded that “despite critical care being a significant healthcare cost burden, there is a paucity of studies evaluating its cost effectiveness” ( 9 ).…”