Determining the economic cost of ICU treatment: a prospective “micro-costing” study

McLaughlin, Anne Marie; Hardt, J; Canavan, James B.; Donnelly, Maria

doi:10.1007/s00134-009-1622-1

Cited by 55 publications

(39 citation statements)

References 18 publications

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“…Based on Irish statistics (unfortunately there are no Dutch statistics available), the estimations are that over e5.3 million per year could be saved in ICU expenses. [4] Most current literature on intoxicated ICU patients focuses on risk factors or prediction models that foretell a bad outcome; seldom on factors predicting an uneventful course. Our study demonstrates that alcohol and "other poisonings" as type of intoxication and an SBP !130 mmHg as individual characteristics, are indicators that ICU treatment will be likely unnecessary.…”

Section: Mechanical Venɵlaɵon N=1970 Cpr N=120mentioning

confidence: 99%

“…In most countries a formal cost analysis is lacking, but Irish ICUs estimated the costs at e7717 per intoxicated patient per ICU admission. [4] A better allocation of intoxicated patients will prevent unnecessary admissions to the ICU, increase the availability of ICU care for those patients that rely on it, and it will reduce costs. However, to create a better allocation it is necessary to identify, from readily available parameters, patients that really need ICU treatment.…”

Section: Introductionmentioning

confidence: 99%

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The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

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Context: Intoxicated patients are frequently admitted from the emergency room to the ICU for observational reasons. The question is whether these admissions are indeed necessary. Objective: The aim of this study was to develop a model that predicts the need of ICU treatment (receiving mechanical ventilation and/or vasopressors <24 h of the ICU admission and/or in-hospital mortality). Materials and methods: We performed a retrospective cohort study from a national ICU-registry, including 86 Dutch ICUs. We aimed to include only observational admissions and therefore excluded admissions with treatment, at the start of the admission that can only be applied on the ICU (mechanical ventilation or CPR before admission). First, a generalized linear mixed-effects model with binominal link function and a random intercept per hospital was developed, based on covariates available in the first hour of ICU admission. Second, the selected covariates were used to develop a prediction model based on a practical point system. To determine the performance of the prediction model, the sensitivity, specificity, positive, and negative predictive value of several cut-off points based on the assigned number of points were assessed. Results: 9679 admissions between January 2010 until January 2015 were included for analysis. In total, 632 (6.5%) of the patients admitted to the ICU eventually turned out to actually need ICU treatment. The strongest predictors for ICU treatment were respiratory insufficiency, age >55 and a GCS <6. Alcohol and "other poisonings" (e.g., carbonmonoxide, arsenic, cyanide) as intoxication type and a systolic blood pressure !130 mmHg were indicators that ICU treatment was likely unnecessary. The prediction model had high sensitivity (93.4%) and a high negative predictive value (98.7%). Discussion and conclusion: Clinical use of the prediction model, with a high negative predictive value (98.7%), would result in 34.3% less observational admissions. ARTICLE HISTORY

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Section: Mechanical Venɵlaɵon N=1970 Cpr N=120mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The need for ICU admission in intoxicated patients: a prediction model

Brandenburg¹,

Brinkman

Keizer

et al. 2016

Clinical Toxicology

View full text Add to dashboard Cite

show abstract

“…The authors of that study used a gross-costing method that was based on healthcare use and average per-unit cost data (17)(18)(19)(20)(21)(22). The cost of asthma-related hospitalizations, for example, was estimated by multiplying the number of asthma hospitalizations by the average cost for one hospitalization (7,23).…”

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confidence: 99%

The Economic Burden of Asthma in the United States, 2008–2013

2018

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Rationale: Asthma is a chronic disease that affects quality of life, productivity at work and school, and healthcare use; and it can result in death. Measuring the current economic burden of asthma provides important information on the impact of asthma on society. This information can be used to make informed decisions about allocation of limited public health resources.Objectives: In this paper, we provide a comprehensive approach to estimating the current prevalence, medical costs, cost of absenteeism (missed work and school days), and mortality attributable to asthma from a national perspective. In addition, we estimate the association of the incremental medical cost of asthma with several important factors, including race/ethnicity, education, poverty, and insurance status. Methods:The primary source of data was the 2008-2013 household component of the Medical Expenditure Panel Survey. We defined treated asthma as the presence of at least one medical or pharmaceutical encounter or claim associated with asthma. For the main analysis, we applied two-part regression models to estimate asthma-related annual per-person incremental medical costs and negative binomial models to estimate absenteeism associated with asthma.Results: Of 213,994 people in the pooled sample, 10,237 persons had treated asthma (prevalence, 4.8%). The annual per-person incremental medical cost of asthma was $3,266 (in 2015 U.S. dollars), of which $1,830 was attributable to prescription medication, $640 to office visits, $529 to hospitalizations, $176 to hospitalbased outpatient visits, and $105 to emergency room visits. For certain groups, the per-person incremental medical cost of asthma differed from that of the population average, namely $2,145 for uninsured persons and $3,581 for those living below the poverty line. During 2008-2013, asthma was responsible for $3 billion in losses due to missed work and school days, $29 billion due to asthma-related mortality, and $50.3 billion in medical costs. All combined, the total cost of asthma in the United States based on the pooled sample amounted to $81.9 billion in 2013.Conclusions: Asthma places a significant economic burden on the United States, with a total cost of asthma, including costs incurred by absenteeism and mortality, of $81.9 billion in 2013. Author Contributions: T.N.: made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data; drafted the submitted article and revised it for important intellectual content; provided final approval of the version to be submitted for publication; and is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; R.K.: made substantial contributions to the design and interpretation of data; revised the article for important intellectual content; made substantial contributions to the text of the drafts of the paper; and provided final approval of the version to be publishe...

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“…In contrast, our practice is characterized by antimold prophylaxis (58% of case patients, 70% of control patients) and C-AT (i.e., voriconazole, posaconazole, caspofungin, L-AMB), with voriconazole (means, 16.9 DDDs/case patient and 3.1 DDDs/control patient; P Ͻ 0.001) and L-AMB (means, 10.7 DDDs/case patient and 0.6 DDDs/control patient; P Ͻ 0.001) predominating principally for empiric or definitive treatment of IFD with AMB-d rarely used due to its recognized toxicities. The high contribution of antifungal treatment to hospitalization costs is also recognized in the ICU, where it is regarded a costly intervention, along with hemodialysis and blood product administration (18).…”

Section: Discussionmentioning

confidence: 99%

Attributable Hospital Cost and Antifungal Treatment of Invasive Fungal Diseases in High-Risk Hematology Patients: an Economic Modeling Approach

Ananda‐Rajah

Cheng

Morrissey

et al. 2011

Antimicrob Agents Chemother

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Improvement in the short-term survival of patients with invasive aspergillosis (IA) (22, 24) is encouraging, but crude mortality rates remain high at Ͼ30% in patients with acute myeloid leukemia (AML) (24) and 57% in hematopoietic stem cell (HSCT) recipients (1). As a result, interest in prevention continues, with efficacy demonstrated for posaconazole in patients receiving induction-remission chemotherapy for AML/ myelodysplastic syndromes (MDSs) and high-risk allogeneic HSCT (allo-HSCT) recipients (7, 32). However, given incidence rates of invasive fungal diseases (IFDs) of 10 to 15% among patients with AML and HSCT recipients (5,17,23), nonselective prophylaxis has raised concerns regarding overtreatment and expenditure (9, 25) because the numbers of eligible patients are high and the duration of prophylaxis is potentially lengthy.Increasingly, the economic impact of IFDs has been considered in the clinical debate. One center, after determining the attributable mean IA-associated medical cost in AML/MDS patients to be €15,280 in association with a 30% institutional incidence, concluded that antimold prophylaxis was likely costbeneficial from the patient and hospital perspectives (29). Cost determination methods for IFDs have included gross costs (16,

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Determining the economic cost of ICU treatment: a prospective “micro-costing” study

Cited by 55 publications

References 18 publications

The need for ICU admission in intoxicated patients: a prediction model

The need for ICU admission in intoxicated patients: a prediction model

The Economic Burden of Asthma in the United States, 2008–2013

Attributable Hospital Cost and Antifungal Treatment of Invasive Fungal Diseases in High-Risk Hematology Patients: an Economic Modeling Approach

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