Economics and Critical Care

Critical care medicine is an extremely costly medical service. With the continuing advances in medical technologies, new drug therapies and technologies as well as changes in clinical practice policies are frequently being proposed. With the increasing demand for the resources available for healthcare, it is imperative to ensure that the resources available for critical care medicine are used in the most efficient way possible.

The aim of this research is to determine which new drugs, new technologies or new clinical practice policies are cost-effective when treating a patient in a critical care setting. Studies currently underway consider a number of different perspectives including that of the patient, the insurer, the hospital and of society as a whole. Data is being collected from clinical trials, as well as from other primary and secondary sources.

The following studies are currently being conducted on economic issues related to critical care patients:

Stress Ulcer Prophylaxis in Critical Care:

Prophylaxis for stress related gastrointestinal bleeding is recommended in critical illness. This study examines whether select proton pump inhibitors relative to other options, are cost-effective for prophylaxis from a hospital perspective.

Economic Evaluation of Treatment Modalities to Prevent Ventilator Associated Pneumonia in Critical Care Patients:

In prolonged ventilation of patients, ventilator-associated pneumonia is common. The condition not only difficult to diagnose, it carries a high mortality and can cause costly extended hospitalizations. There has been much research into the prevention of this hospital acquired pneumonia with the development of new technologies and clinical practice policies. A cost-effectiveness analysis will be performed comparing silver coated endotracheal tubes, continuous subglottic suctioning tubes, and application of 0.12% chlorhexidine as compared to existing practice of plain endotracheal tubes. The analysis will assess which tube is the most cost effective for placement in any patient that is anticipated to be ventilated for longer than 24hrs considering the tubes effectiveness in preventing ventilator-associated pneumonia and the costs associated with each modality including cost of the modality and cost of the modalities clinical outcomes. The analysis will be conducted from the perspective of the hospital with the unit of effectiveness being the number of days free of ventilator associated pneumonia.

Economic Evaluation of an Intra-Operative Lung Protection Study:

Research has documented the influence of multiple factors contributing to peri-operative respiratory failure. This study will evaluate the effect of a lung protective protocol on reducing the risk of peri-operative respiratory failure. Specifically, the protocol will address the reduction in risk of pneumonia and perioperative atelectasis and its relationship to the reduction in hospital length of stay for high risk patients undergoing surgery, and to improve the overall survival of these high risk patients undergoing surgery. In addition, this study will address the potential reduction in ventilator days, the reduction in iatrogenic complications, the reduction in peri-operative intubation rate and the reduction in ventilator associated pneumonia in an economic impact context.

Hemodynamic Monitoring in Critical Care (LiDCO):

Hemodynamic monitoring is critical in informing clinicians of a patient’s circulatory status, especially in the critically ill suffering from shock. The LiDCO Plus monitor provides continuous and real time hemodynamic monitoring and makes use of lines already in place in a critically ill patient. Potentially, the use of the LiDCO plus monitor will allow earlier goal-directed therapy for critically ill patients suffering from shock producing better patient outcomes, reduced adverse events and shorter duration of hospital stay as compared to the existing practice of pulmonary arterial catheters. The aim of this study is to conduct an economic evaluation of the LiDCO plus monitor compared to pulmonary artery in critically ill patients suffering from shock admitted to the surgical intensive care unit (SICU) from the hospital and insurer perspective.

Adjunctive Hyperbaric Oxygen Therapy for the Management of Infected Pancreatic Pseudocysts:

Even though hyperbaric therapy is often considered a costly treatment modality, health outcomes without it are often be more costly over time, especially when quality of life is considered. An example of an existing study is examining the cost-effectiveness of adjunctive hyperbaric therapy for the management of patients with infected pancreatic pseudocysts. About 5-16% of patients with acute pancreatitis develop pseudocysts. About 10% of these cysts become infected, pose a threat to life and are functionally disabling. This study aims to determine if using adjunctive hyperbaric oxygen therapy could significantly facilitate resolution of infected pseudocysts and whether it is cost-effective from a societal perspective in terms of cost per quality adjusted life year gained.