Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 4, 2016; 5(2): 150-164
Published online May 4, 2016. doi: 10.5492/wjccm.v5.i2.150
Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients
Hajrunisa Cubro, Rabija Somun-Kapetanovic, Guillaume Thiery, Daniel Talmor, Ognjen Gajic
Hajrunisa Cubro, Guillaume Thiery, Medical Intensive Care Unit, Sarajevo University Clinical Center, Sarajevo 71000, Bosnia and Herzegovina
Rabija Somun-Kapetanovic, Department of Quantitative Economics, Faculty of Economics, Sarajevo 71000, Bosnia and Herzegovina
Daniel Talmor, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
Ognjen Gajic, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Cubro H, Somun-Kapetanovic R and Thiery G collected and analyzed the data; Cubro H, Talmor D and Gajic O designed the work; Cubro H, Talmor D and Gajic O interpreted the results; Cubro H wrote the first draft; Cubro H, Thiery G, Talmor D and Gajic O revised the manuscript for important intellectual content and gave approval for publication.
Institutional review board statement: The study was reviewed and approved by the Institutional review board of Sarajevo University Clinical Center and Ehics commitee of the Sarajevo University Faculty of Medicine.
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors of this study declare that they have no conflict of interest to disclose.
Data sharing statement: There is no additional data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ognjen Gajic, MD, Professor of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States. gajic.ognjen@mayo.edu
Telephone: +1-507-2556051 Fax: +1-507-2554267
Received: April 9, 2015
Peer-review started: April 9, 2015
First decision: September 14, 2015
Revised: October 20, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: May 4, 2016
Abstract

AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources.

METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed.

RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.

CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services.

Keywords: Cost benefit analysis, Intensive care, Quality of life, Intensive care unit, Mortality, Decision analysis, Economics

Core tip: The first of a kind prospective cost effectiveness study in the intensive care unit in low resource settings. The study provides important evidence that critical care is cost effective medical intervention that favorably compares with most standard medical treatments but is unfortunately grossly underdeveloped in low resource settings.