IS IT WORTHWHILE TO CONTINUE TREATING PATIENTS WITH A PROLONGED STAY (GREATER-THAN-14 DAYS) IN THE ICU - AN ECONOMIC-EVALUATION

Objective: To compare the cost and consequences of a policy of continu ing to care for patients with a prolonged stay in the ICU with a propo sed policy of withdrawing support, Design: Economic evaluation using d ata derived from a prospective cohort study. Setting: Adult medical/su rgical ICU in a tertiary care hospital. Patients: Consecutive patients admitted to the ICU. Intervention: None. Main outcome measures: We pe rformed a cost-accounting analysis on each patient in the ICU and foll owed up patients until 12 months after admission to ICU and assessed c omponents of quality of Life in survivors. Results: During the study p eriod, 690 patients were admitted to the ICU. Only 61 (9%) patients re mained in the ICU for >14 days, For this group, the mean length of sta y 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 mot differ between patients wit h a short or prolonged stay in the ICU. The average ICU cost per day p er patient was $1,565 (Canadian) resulting in a total cost for the who le cohort of Can $1,917,382, Over the same time period, 58 patients ha d life support withdrawn. On average, patients survived another day in the ICU, 2 more clays 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 cons iderable proportion of patients with a prolonged length of slay in the ICU survive their critical illness, Furthermore, their long-term qual ity of life seems reasonable. Our data suggest that continuing treatme nt for patients with a prolonged ICU stay may represent an efficient u se of hospital resources and should be considered in the context of lo cal budgets.