Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest

Abstract

Introduction: The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation.

Methods: Five-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs, hospital costs and post-hospital health care costs per survivor, costs per life year gained, and costs per quality-adjusted life year gained of patients admitted to a single ICU were assessed.

Results: One hundred ten of 354 patients (31%) were alive 5 years after hospital discharge. The mean health status index of 5-year survivors was 0.77 (95% confidence interval 0.70 to 0.85). Women rated their health-related quality of life significantly better than men did (0.87 versus 0.74; P < 0.05). Costs per hospital discharge survivor were 49,952 euro. Including the costs of post-hospital discharge health care incurred during their remaining life span, the total costs per life year gained were 10,107 euro. Considering 5-year survivors only, the costs per life year gained were calculated as 9,816 euro or 14,487 euro per quality-adjusted life year gained. Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 euro.

Conclusion: Patients who leave the hospital following cardiac arrest without severe neurological disabilities may expect a reasonable quality of life compared with age- and gender-matched controls. Quality-adjusted costs for this patient group appear to be within ranges considered reasonable for other groups of patients.

Figure 1

From January 1999 to December 2001, a total of 2,806 patients were admitted to the medical intensive care unit (ICU). Of those patients, 354 (13%) had a cardiac arrest with subsequent cardiopulmonary resuscitation out of hospital, in hospital, or both and thus qualified for study entry.

Figure 2

Medical Outcome Survey Short Form-36 questionnaire (SF-36) of 81 long-term survivors after cardiopulmonary resuscitation. Each scale is normalized to a mean of 50, which is considered normal on the basis of comparison of SF-36 scores in a general gender- and age-matched German control (norm population). The vertical line represents the median, and the left and right limits of the boxes represent the quartiles. Cronbach's alpha coefficient exceeded 0.7 in all domains, demonstrating acceptable agreement of the various items.

Figure 3

Two-way sensitivity analysis depicting costs per quality-adjusted life year (QALY) saved considering both an increase and a decrease in health status index 5 years post-intensive care unit of 25% and 50%, respectively (bold solid line). Moreover, the remaining life years were modelled, again considering an increase and a decrease of 25% (fine line) and 50% (dashed line), respectively.