Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system

Abstract

Objectives: There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY).

Setting: We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention).

Participants: Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system.

Results: Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1-2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50,000, cost per CPC 1-2 survivor was £65,000. Cost and length of stay of CPC 1-2 patients was considerably lower than CPC 3-4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1-2 survivor per QALY was £16,000.

Conclusions: The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.

Figure 1

Payment by Results System Cost Calculation.

Figure 2

Presentation of OOHCA patients to our regional centre. Flow of patients presenting with OOHCA to our hospital. A total of 157 patients were brought by ambulance to our institution. Fifty-six of these were admitted to intensive care unit (ICU) and 101 were not admitted to ICU. A further 13 patients were admitted to our ICU following OOHCA presenting to another hospital (total 69 patients). Of the ICU patients 33 survived to hospital discharge, 28 died (21 on ICU, 7 on the ward subsequently). Of the 101 OOHCA not admitted to ICU at our institution 37 were discharged from hospital alive, 64 died. Of these 44 died in A&E, 6 died in the theatre/recovery area (prior to transfer to definitive ICU bed), 4 died in the catheter laboratory and 10 died on the wards.

Figure 3

Graph demonstrating costs (median, 25th and 75th centiles and minimum and maximum values) both for ICU (light grey) and total (ICU and non-ICU) stay in hospital (dark grey) for different outcome groups.

Figure 4

Graph demonstrating length of stay (median, 25th and 75th centiles and minimum and maximum values) both for ICU (light grey) and total (ICU and non-ICU) stay in hospital (dark grey) for different outcome groups.