Keuffel Eric L, Stevens Mitali, Gunnarsson Candace, Rizzo John, Sessler Daniel I, Maheshwari Kamal
a Health Finance & Access Initiative , Chester , PA , USA.
b Edwards Lifesciences , Irvine , CA , USA.
J Med Econ. 2019 Apr;22(4):383-389. doi: 10.1080/13696998.2019.1576695. Epub 2019 Feb 19.
This economic analysis extends upon a recent epidemiological study to estimate the association between hypotension control and hospital costs for septic patients in US intensive care units (ICUs).
A Monte Carlo simulation decision analytic model was developed that accounted for the probability of complications-acute kidney injury and mortality-in septic ICU patients and the cost of each health outcome from the hospital perspective. Probabilities of complications were calculated based on observational data from 110 US hospitals for septic ICU patients (n = 8,782) with various levels of hypotension exposure as measured by mean arterial pressure (MAP, units: mmHg). Costs for acute kidney injury (AKI) and mortality were derived from published literature. Each simulation calculated mean hospital cost reduction and 95% confidence intervals based on 10,000 trials.
In the base-case analysis hospital costs for a hypothetical "control" cohort (MAP of 65 mmHg) were $699 less per hospitalization (95% CI: $342-$1,116) relative to a "case" cohort (MAP of 60 mmHg). In the most extreme case considered (45 mmHg vs 65 mmHg), the associated cost reduction was $4,450 (95% CI: $2,020-$7,581). More than 99% of the simulated trials resulted in cost reductions. A conservative institution-level analysis for a hypothetical hospital (which assumes no benefit for increasing MAP above 65 mmHg) estimated a cost decline of $417 for a 5 mmHg increase in MAP per ICU septic patient. These results are applicable to the US only.
Hypotension control (via MAP increases) for patients with sepsis in the ICU is associated with lower hospitalization cost.
本经济分析是在最近一项流行病学研究的基础上进行扩展，以估计美国重症监护病房（ICU）中脓毒症患者的低血压控制与住院费用之间的关联。
开发了一个蒙特卡洛模拟决策分析模型，该模型考虑了脓毒症ICU患者发生急性肾损伤和死亡等并发症的概率，以及从医院角度看每种健康结局的成本。并发症的概率是根据美国110家医院中脓毒症ICU患者（n = 8782）的观察数据计算得出的，这些患者的低血压暴露程度通过平均动脉压（MAP，单位：mmHg）来衡量。急性肾损伤（AKI）和死亡的成本来自已发表的文献。每次模拟基于10000次试验计算平均住院费用降低情况和95%置信区间。
在基础案例分析中，假设的“对照”队列（MAP为65 mmHg）的住院费用相对于“病例”队列（MAP为60 mmHg）每次住院少699美元（95%置信区间：342美元 - 1116美元）。在考虑的最极端情况下（45 mmHg对65 mmHg），相关的成本降低为4450美元（95%置信区间：2020美元 - 7581美元）。超过99%的模拟试验导致成本降低。对一家假设医院进行的保守机构层面分析（假设将MAP提高到65 mmHg以上没有益处）估计，每位ICU脓毒症患者的MAP每升高5 mmHg，成本下降417美元。这些结果仅适用于美国。
ICU中脓毒症患者的低血压控制（通过提高MAP）与较低的住院费用相关。
