Cost effectiveness of intensive care in the UK

Mclaughlin, M., McPeake, J. , Kinsella, J. and Quasim, T. (2015) Cost effectiveness of intensive care in the UK. Critical Care Medicine, 43(12), p. 326. (doi: 10.1097/01.ccm.0000475128.47120.a0) (PMID:26570957)

Abstract

Learning Objectives: In the UK the National Institute for Health and Care Excellence requires a new treatment to reach a cost effectiveness threshold of between $31200 and $46900 per Quality Adjusted Life Year (QALY) to be considered for implementation in the NHS. A 2007 UK study suggested that the incremental cost per QALY gain of treatment in ICU was ($10918) and therefore cost effective. This analysis was based on a health utility score of 0.66 and no increase in health care utilization after ICU. This current study modelled the cost-effectiveness of ICU using 4 different scenarios. Methods: Previous work in our hospital has shown that QoL and health utility scores, after ICU are affected by work status (employed (0.77) vs retired (0.62) vs unemployed (0.08) vs long term sick (0.05)). Using the standardized UK costs, we ran 4 models. Assuming the status quo with updated UK healthcare costs, QoL is poorer after ICU but no increase in healthcare utilization, increased health care utilization after ICU (2,3 or 5 times the population norm) but QoL is 0.66, both QoL is poorer and health care utilization is increased. Results: With the updated status quo the cost per QALY is $15049. When the population is divided into the employed, retired, unemployed and the chronically sick the costs per QALY are $12917, $16019, $121124 and $187400. If the health utility is assumed to be 0.66 but we assume increased healthcare utilization of 2, 3 and 5 times the population norm the costs per QALY are $20036, $25021, $34995. If there is both a poorer QoL and increased healthcare utilization the costs per QALY range from $17195 to $435783. Conclusions: Whilst many patients return to an acceptable level of health, many struggle physically, financially, socially and psychologically. Although potentially the minority of patients, these groups are of working age and pose a significant economic burden to society. Small, targeted changes are required to improve QoL and the cost per QALY for ICU services. A holistic approach with generic and vocational rehabilitation is required if we are to prevent recurrent ill health and dependency.

• Item Type: Articles
• Additional Information: Critical Care Congress, Orlando, FL, USA, 20-24 Feb 2016.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mclaughlin, Dr Michael and Quasim, Professor Tara and Kinsella, Professor John and McPeake, Dr Jo
• Authors: Mclaughlin, M., McPeake, J., Kinsella, J., and Quasim, T.
• Subjects: R Medicine > R Medicine (General); R Medicine > RT Nursing
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Critical Care Medicine
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0090-3493
• ISSN (Online): 1530-0293