Background

Cost considerations may influence therapeutic reasoning and decisions in the intensive care unit (ICU). To date only very few data illuminating the association of costs and consequences (i.e. outcomes) of critical care services are available. In this study, the long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed.

Methods

Between October 1997 and February 1998 all consecutive patients admitted to the medical ICU of a university hospital were enrolled. The SAPS II, SOFA and TISS-28 scores, and individual ICU and hospital costs were prospectively recorded. Five years later, survival and HRQL were assessed using an established methodology (Medical Outcome Short Form [SF-36]). Effective costs per survivor (i.e. all costs divided by survivors [ECPS]) for the index hospitalization, as well as quality-adjusted life years (SF-36 fraction of an age-matched, apparently healthy control × the years of survival [QALY]) were calculated.

Results

Three-hundred and three patients mainly suffering from cardiovascular and pulmonary diseases were enrolled. The mean SAPS II score was 26 points, mean age was 62 years, 71% were male, with a mean length of ICU stay of 3.7 days. Forty-four patients (14.5%) died while in hospital. After 5 years 196 patients (65%) were still alive, and 157 patients (80%) completed the questionnaire. The majority of patients lived independently at home (80%); only 11% were in need of care. Thirty-one patients (20%) reported unpleasant memories with regard to the ICU stay. The health status index of the sample was 79.4%, corresponding to 4 QUALY. The mean ECPS were €12.404 for 5 years and €2481 per life year saved, respectively. The mean costs per QUALY were €3101. Increasing severity of illness (SAPS II quartiles) was associated with higher ECPS and costs per QUALY (Table 1).

Table 1
Full size table

Conclusion

A large proportion of patients survived > 5 years and reported a good HRQL. Considering the severity of illness and the patients' outcome, ECPS and costs per QALY were low compared with other therapeutic approaches (e.g. beta-blocker postmyocardial infarction, €20,000 per added life year).