Is it 'worthwhile' to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation.

OBJECTIVE

To compare the cost and consequences of a policy of continuing to care for patients with a prolonged stay in the ICU with a proposed policy of withdrawing support.

DESIGN

Economic evaluation using data derived from a prospective cohort study.

SETTING

Adult medical/surgical ICU in a tertiary care hospital.

PATIENTS

Consecutive patients admitted to the ICU.

INTERVENTION

None.

MAIN OUTCOME MEASURES

We performed a cost-accounting analysis on each patient in the ICU and followed up patients until 12 months after admission to ICU and assessed components of quality of life in survivors.

RESULTS

During the study period, 690 patients were admitted to the ICU. Only 61 (9%) patients remained in the ICU for > 14 days. For this group, the mean length of stay in the ICU was 24.5 (+/-11.7) days and duration in hospital was 57.9 (+/-56.9) days. At 12 months, 27 (44%) were alive. Overall, the mean quality of life score at 12 months did not differ between patients with a short or prolonged stay in the ICU. The average ICU cost per day per patient was $1,565 (Canadian) resulting in a total cost for the whole cohort of Can $1,917,382. Over the same time period, 58 patients had life support withdrawn. On average, patients survived another day in the ICU, 2 more days in hospital, and all patients ultimately died. When treatment was discontinued, the costs of treating this cohort was Can $156,465. The incremental cost-effectiveness ratio is Can $65,219 per life saved or Can $4,350 per life-year saved.

CONCLUSIONS

A considerable proportion of patients with a prolonged length of stay in the ICU survive their critical illness. Furthermore, their long-term quality of life seems reasonable. Our data suggest that continuing treatment for patients with a prolonged ICU stay may represent an efficient use of hospital resources and should be considered in the context of local budgets.