Relative cost and outcomes in the intensive care unit of acute lung injury (ALI) due to pandemic influenza compared with other etiologies: a single-center study

Abstract

BackgroundCritical illness due to 2009 H1N1 influenza has been characterized by respiratory complications, including acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), and associated with high mortality. We studied the severity, outcomes, and hospital charges of patients with ALI/ARDS secondary to pandemic influenza A infection compared with ALI and ARDS from other etiologies.MethodsA retrospective review was conducted that included patients admitted to the Cleveland Clinic MICU with ALI/ARDS and confirmed influenza A infection, and all patients admitted with ALI/ARDS from any other etiology from September 2009 to March 2010. An itemized list of individual hospital charges was obtained for each patient from the hospital billing office and organized by billing code into a database. Continuous data that were normally distributed are presented as the mean ± SD and were analyzed by the Student’s t test. The chi-square and Fisher exact tests were used to evaluate differences in proportions between patient subgroups. Data that were not normally distributed were compared with the Wilcoxon rank-sum test.ResultsForty-five patients were studied: 23 in the H1N1 group and 22 in the noninfluenza group. Mean ± SD age was similar (44 ± 13 and 51 ± 17 years, respectively, p = 0.15). H1N1 patients had lower APACHE III scores (66 ± 20 vs. 89 ± 32, p = 0.015) and had higher Pplat and PEEP on days 1, 3, and 14. Hospital and ICU length of stay and duration of mechanical ventilation were comparable. SOFA scores over the first 2 weeks in the ICU indicate more severe organ failure in the noninfluenza group (p = 0.017). Hospital mortality was significantly higher in the noninfluenza group (77 vs. 39%, p = 0.016). The noninfluenza group tended to have higher overall charges, including significantly higher cost of blood products in the ICU.ConclusionsALI/ARDS secondary to pandemic influenza infection is associated with more severe respiratory compromise but has lower overall acuity and better survival rates than ALI/ARDS due to other causes. Higher absolute charges in the noninfluenza group are likely due to underlying comorbid medical conditions.

Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score–Matched, Nationwide, Population-Based Cohort Study

“…To our knowledge, the present study is the first population-based study to demonstrate that the protective effect of influenza vaccine in reducing all-cause mortality, influenza-related hospitalization, LOS, and medical expenditure in elderly individuals with disability. Medical expenditure of individuals with influenza, including those with influenza-related complications such as pneumonia [24], respiratory diseases [25], respiratory failure [26,27], heart disease [28][29][30], hemorrhagic stroke [31], and ischemic stroke [30], has often led to higher spending. In our study, we found that influenza vaccination was associated with reductions in all-cause mortality, influenza-related hospitalization, LOS, and medical costs decreased among elderly individuals with a disability (Tables 1 and 2).…”

Real-Time Surveillance of Influenza Morbidity: Tracking Intensive Care Unit Resource Utilization

“…Hospitals treating critically ill patients with influenza utilize numerous resources during the influenza season, including ICU beds and time from physicians, nurses, and other ICU staff. Most patients admitted to ICUs with influenza receive mechanical ventilation (16,17); thus, adequate numbers of ventilators and specialized support staff, such as respiratory therapists, are also necessary resources. ECMO can be an effective salvage therapy for patients with acute respiratory distress syndrome or cardiopulmonary failure from H1N1 influenza (9, 18-21).…”

Using Incentives to Improve Resource Utilization

“…laboratory tests, pharmaceuticals, blood products) are important contributors to rising healthcare costs. 23–25 ABGs, CXRs, and RBCs are commonly utilized resources across multiple ICUs with evidence that utilization can be safely reduced. We present a multifaceted quality improvement intervention built around financial incentives that significantly reduced utilization rates of these resources across seven ICUs.…”