Petrie J, Easton S, Naik V, Lockie C, Brett S J, Stümpfle R
Centre for Perioperative Medicine and Critical Care Research, London, UK.
Finance Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
BMJ Open. 2015 Apr 2;5(4):e005797. doi: 10.1136/bmjopen-2014-005797.
There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY).
We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention).
Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system.
Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1-2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50,000, cost per CPC 1-2 survivor was £65,000. Cost and length of stay of CPC 1-2 patients was considerably lower than CPC 3-4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1-2 survivor per QALY was £16,000.
The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.
关于院外心脏骤停（OOHCA）幸存者的医院治疗费用的文献稀缺，尤其是在英国。这对于评估在国民医疗服务体系内合理分配资源所需干预措施的成本效益至关重要。我们主要旨在计算根据医院生存情况和神经学结果分层的费用。其次，我们根据先前研究的生存和效用估计值来估计成本效益，以计算每质量调整生命年（QALY）的成本。
我们对2011年1月起18个月内院外心脏骤停后自主循环恢复（ROSC）并入住重症监护病房（ICU）的患者的住院费用进行了单中心（伦敦）回顾性研究（在广泛引入目标温度管理和初级经皮介入之后）。
在18个月期间连续收治的69例患者中，通过数据库和临床记录回顾获得了生存情况和脑功能分类（CPC）结果。信托财务部门使用英国按结果付费系统提供了ICU和医院费用。
入住ICU且有ROSC的患者中，出院存活（任何CPC）的有33/69（48%），出院时CPC为1 - 2级的存活者有26/33。出院存活者的人均费用（包括存活者和非存活者的总费用）为50,000英镑，CPC 1 - 2级存活者的人均费用为65,000英镑。CPC 1 - 2级患者的费用和住院时间明显低于CPC 3 - 4级患者。大部分费用（69%）与重症监护有关。每CPC 1 - 2级存活者每QALY的估计成本为16,000英镑。
院外心脏骤停后ROSC入住ICU的患者的住院护理费用相当可观，但从QALY角度评估时处于合理阈值内。
