Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
BMJ Open. 2024 Apr 28;14(4):e078435. doi: 10.1136/bmjopen-2023-078435.
We aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.
We conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method. The impact on productivity was assessed using a Markov state-transition model with a 3-year horizon.
Patients older than 18 years of age with shock not related to trauma who received care by EMS (1 January 2015-30 June 2019) in Victoria, Australia were included in the analysis.
The primary outcome assessed was the total healthcare expenditure. Secondary outcomes included healthcare expenditure stratified by shock aetiology, years of life lived (YLL), productivity-adjusted life-years (PALYs) and productivity losses.
A total of 21 334 patients (mean age 65.9 (±19.1) years, and 9641 (45.2%) females were treated by EMS with non-traumatic shock with an average healthcare-related cost of $A11 031 per episode of care and total cost of $A280 million. Annual costs remained stable throughout the study period, but average costs per episode of care increased (P=0.05). Among patients who survived to hospital, the average cost per episode of care was stratified by aetiology with cardiogenic shock costing $A24 382, $A21 254 for septic shock, $A19 915 for hypovolaemic shock and $A28 057 for obstructive shock. Modelling demonstrated that over a 3-year horizon the cohort lost 24 355 YLLs and 5059 PALYs. Lost human capital due to premature mortality led to productivity-related losses of $A374 million. When extrapolated to the entire Australian population, productivity losses approached $A1.5 billion ($A326 million annually).
The direct healthcare costs and indirect loss of productivity among patients with non-traumatic shock are high. Targeted public health measures that seek to reduce the incidence of shock and improve systems of care are needed to reduce the financial burden of this syndrome.
评估因急救医疗服务（EMS）治疗非创伤性休克而产生的医疗保健费用和对整体经济的影响。
我们进行了一项基于人群的队列研究，其中 EMS 治疗的患者个体与医院范围和全州范围的行政数据集相关联。使用病例组合资金方法估算了护理各个方面的直接医疗保健费用（澳元，AUD）。使用具有 3 年期限的马尔可夫状态转移模型评估对生产力的影响。
在澳大利亚维多利亚州，纳入年龄大于 18 岁、因休克而非创伤接受 EMS 治疗（2015 年 1 月 1 日至 2019 年 6 月 30 日）的非创伤性休克患者。
主要结局评估是总医疗支出。次要结局包括按休克病因、预期寿命（YLL）、调整后的生产力生命年（PALYs）和生产力损失划分的医疗支出。
共有 21334 名（平均年龄 65.9（±19.1）岁，9641 名（45.2%）为女性）患者因非创伤性休克接受 EMS 治疗，每次治疗的平均医疗相关费用为 11031 澳元，总费用为 2.8 亿澳元。在整个研究期间，年度成本保持稳定，但每次治疗的平均费用增加（P=0.05）。在存活至医院的患者中，每次治疗的平均费用按病因分类，心源性休克为 24382 澳元，脓毒性休克为 21254 澳元，低血容量性休克为 19915 澳元，梗阻性休克为 28057 澳元。模型表明，在 3 年期间，该队列损失了 24355 年预期寿命和 5059 个调整后的生产力生命年。由于过早死亡导致的人力资本损失导致与生产力相关的损失为 3.74 亿澳元。当外推到整个澳大利亚人口时，生产力损失接近 15 亿澳元（每年 3260 万澳元）。
非创伤性休克患者的直接医疗保健费用和间接生产力损失很高。需要有针对性的公共卫生措施来降低休克的发病率并改善护理系统，以减轻这种综合征的经济负担。
