Outcomes and healthcare-associated costs one year after intensive care-treated cardiac arrest

Abstract

Background: Despite the significant socioeconomic burden associated with cardiac arrest (CA), data on CA patients' long-term outcome and healthcare-associated costs are limited. The aim of this study was to determine one-year survival, neurological outcome and healthcare-associated costs for ICU-treated CA patients.

Methods: This is a single-centre retrospective study on adult CA patients treated in Finnish tertiary hospital's ICUs between 2005 and 2013. Patients' personal identification number was used to crosslink data between several nationwide databases in order to obtain data on one-year survival, neurological outcome, and healthcare-associated costs. Healthcare-associated costs were calculated for every patient stratified by cardiac arrest location (OHCA = out-of-hospital cardiac arrest, IHCA = all in-hospital cardiac arrest, ICU-CA = in-ICU cardiac arrest) and initial cardiac rhythm. Cost-effectiveness was estimated by dividing total healthcare-associated costs for all patients from the respective group by the number of survivors and survivors with favourable neurological outcome.

Results: The study population included 1,024 ICU-treated CA patients. The sum of costs for all patients was €50,847,540. At one-year after CA, 58% of OHCAs, 44% of IHCAs, and 39% of ICU-CAs were alive. Of one-year survivors 97% of OHCAs, 88% of IHCAs, and 93% of ICU-CAs had favourable neurological outcome. Effective cost per one-year survivor was €76,212 for OHCAs, €144,168 for IHCAs, and €239,468 for ICU-CAs. Effective cost per one-year survivor with favourable neurological outcome was €81,196 for OHCAs, €164,442 for IHCAs, and €257,207 for ICU-CAs.

Conclusions: In-ICU CA patients had the lowest one-year survival with the effective cost per survivor three times higher than for OHCAs.

Keywords: Cardiac arrest; Cost-effectiveness; Healthcare costs; Long-term outcome; Neurological outcome; Outcome; Survival.