Talmor Daniel, Shapiro Nathan, Greenberg Dan, Stone Patricia W, Neumann Peter J
Department of Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Crit Care Med. 2006 Nov;34(11):2738-47. doi: 10.1097/01.CCM.0000241159.18620.AB.
Receiving care in an intensive care unit can greatly influence patients' survival and quality of life. Such treatments can, however, be extremely resource intensive. Therefore, it is increasingly important to understand the costs and consequences associated with interventions aimed at reducing mortality and morbidity of critically ill patients. Cost-effectiveness analyses (CEAs) have become increasingly common to aid decisions about the allocation of scarce healthcare resources.
To identify published original CEAs presenting cost/quality-adjusted life year or cost/life-year ratios for treatments used in intensive care units, to summarize the results in an accessible format, and to identify areas in critical care medicine that merit further economic evaluation.
We conducted a systematic search of the English-language literature for original CEAs of critical care interventions published from 1993 through 2003. We collected data on the target population, therapy or program, study results, analytic methods employed, and the cost-effectiveness ratios presented.
We identified 19 CEAs published through 2003 with 48 cost-effectiveness ratios pertaining to treatment of severe sepsis, acute respiratory failure, and general critical care interventions. These ratios ranged from cost saving to 958,423 US dollars/quality-adjusted life year and from 1,150 to 575,054 US dollars/life year gained. Many studies reported favorable cost-effectiveness profiles (i.e., below 50,000 US dollars/life year or quality-adjusted life year).
Specific interventions such as activated protein C for patients with severe sepsis have been shown to provide good value for money. However, overall there is a paucity of CEA literature on the management of the critically ill, and further high-quality CEA is needed. In particular, research should focus on costly interventions such as 24-hr intensivist availability, early goal-directed therapy, and renal replacement therapy. Recent guidelines for the conduct of CEAs in critical care may increase the number and improve the quality of future CEAs.
在重症监护病房接受治疗会极大地影响患者的生存和生活质量。然而，此类治疗可能极其耗费资源。因此，了解旨在降低危重症患者死亡率和发病率的干预措施的成本及后果变得愈发重要。成本效益分析（CEA）已越来越普遍，以辅助关于稀缺医疗资源分配的决策。
识别已发表的原始成本效益分析，呈现重症监护病房所用治疗的成本/质量调整生命年或成本/生命年比率，以易于理解的格式总结结果，并确定重症医学中值得进一步进行经济评估的领域。
我们对1993年至2003年发表的关于重症监护干预措施的英文原始成本效益分析文献进行了系统检索。我们收集了关于目标人群、治疗或项目、研究结果、所用分析方法以及呈现的成本效益比率的数据。
我们识别出截至2003年发表的19项成本效益分析，其中48个成本效益比率涉及严重脓毒症、急性呼吸衰竭的治疗以及一般重症监护干预措施。这些比率范围从节省成本到958,423美元/质量调整生命年，以及从1,150美元到575,054美元/获得的生命年。许多研究报告了良好的成本效益情况（即低于50,000美元/生命年或质量调整生命年）。
特定干预措施，如用于严重脓毒症患者的活化蛋白C，已被证明具有良好的性价比。然而，总体而言，关于危重症管理的成本效益分析文献较少，需要进一步的高质量成本效益分析。特别是，研究应聚焦于成本高昂的干预措施，如24小时有重症医学专家可用、早期目标导向治疗以及肾脏替代治疗。近期关于重症监护中成本效益分析实施的指南可能会增加未来成本效益分析的数量并提高其质量。
