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Multicenter Study
. 2010;14(2):R60.
doi: 10.1186/cc8957. Epub 2010 Apr 12.

One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure

Rita Linko  1 , Raili Suojaranta-Ylinen, Sari Karlsson, Esko Ruokonen, Tero Varpula, Ville Pettilä; FINNALI study investigators
Collaborators, Affiliations
Multicenter Study

One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure

Rita Linko et al. Crit Care. 2010.

Abstract

Introduction: High daily intensive care unit (ICU) costs are associated with the use of mechanical ventilation (MV) to treat acute respiratory failure (ARF), and assessment of quality of life (QOL) after critical illness and cost-effectiveness analyses are warranted.

Methods: Nationwide, prospective multicentre observational study in 25 Finnish ICUs. During an eight-week study period 958 consecutive adult ICU patients were treated with ventilatory support over 6 hours. Of those 958, 619 (64.6%) survived one year, of whom 288 (46.5%) answered the quality of life questionnaire (EQ-5D). We calculated EQ-5D index and predicted lifetime quality-adjusted life years (QALYs) gained using the age- and sex-matched life expectancy for survivors after one year. For expired patients the exact lifetime was used. We divided all hospital costs for all ARF patients by the number of hospital survivors, and by all predicted lifetime QALYs. We also adjusted for those who died before one year and for those with missing QOL to be able to estimate the total QALYs.

Results: One-year mortality was 35% (95% CI 32 to 38%). For the 288 respondents median [IQR] EQ-5D index after one year was lower than that of the age- and sex-matched general population 0.70 [0.45 to 0.89] vs. 0.84 [0.81 to 0.88]. For these 288, the mean (SD) predicted lifetime QALYs was 15.4 (13.3). After adjustment for missing QOL the mean predicted lifetime (SD) QALYs was 11.3 (13.0) for all the 958 ARF patients. The mean estimated costs were 20.739 euro per hospital survivor, and mean predicted lifetime cost-utility for all ARF patients was 1391 euro per QALY.

Conclusions: Despite lower health-related QOL compared to reference values, our result suggests that cost per hospital survivor and lifetime cost-utility remain reasonable regardless of age, disease severity, and type or duration of ventilation support in patients with ARF.

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Figures

Figure 1
Figure 1
Flow-chart of study population for quality of life and cost-utility evaluation. ARF, acute respiratory failure; QALY, quality-adjusted life years.
Figure 2
Figure 2
EQ-5D index of respondents of acute respiratory failure at one year compared with reference values. Patients are divided to (a) post-operative patients with short (< 1 day) ventilatory support and (b) other patients. P = 0.005 in age group 65 to 74 years.
Figure 3
Figure 3
Estimated mean costs and predicted lifetime quality-adjusted life years (QALY) and costs per QALY in different age groups.
See this image and copyright information in PMC

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