Cost Effectiveness Analysis of Critical Care in Resource Limited Setting

Study Overview
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Brief Summary
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The purpose of this study was to examine the cost effectiveness of critical care in a middle income country with limited resources. The main study hypothesis was that critical care is cost effective in low resources setting.

Detailed Description
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The investigators objective was to calculate the cost effectiveness of treatment of critically ill patients in a medical ICU of a middle income country with limited access to ICU resources. Methods: Consecutive critically ill medical patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina, were prospectively recorded and a subsequent cost utility analysis of intensive care in comparison to hospital ward treatment from the perspective of health care system was performed. Incremental cost effectiveness was calculated using estimates of ICU versus 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.

Official Title
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Cost Effectiveness of Intensive Care in a Low Resource Setting: Prospective Cohort of Medical Critically Ill Patients

Conditions
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Critical Illness

Intervention / Treatment
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* Procedure: mechanical ventilation
* Procedure: neuromuscular blockade
* Procedure: renal replacement therapy
* Procedure: non-invasive ventilation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients treated between June 1 2011 and June 29 2012 in the medical ICU Exclusion Criteria: Patients who stayed in the ICU less than 24 hours and hospital readmissions
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ICU patients<br>The actual cohort of 148 critically ill medical patients that received the treatment in the intensive care unit (ICU). The interventions include interventions that are usually performed within the ICU such as mechanical ventilation, non-invasive ventilation, neuromuscular blockade, renal replacement therapy. | Procedure: mechanical ventilation<br>* ventilator support for the patients presenting with acute respiratory failure<br>* Other names: ventilator;Procedure: neuromuscular blockade<br>* paralysis of the skeletal muscles in order to optimize mechanical ventilation, especially during ARDS<br>* Other names: neuromuscular block;Procedure: renal replacement therapy<br>* the procedures used to treat acute kidney injury<br>* Other names: continuous hemofiltration (CHF) or hemodiafiltration (CHDF);Procedure: non-invasive ventilation<br>* Procedure used for ventilation support in patients with congestive heart failure, pulmonary edema, COPD and some other conditions.<br>* Other names: continuous positive airway pressure (CPAP);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| survival | mortality was recorded one year after hospital discharge and subtracted from the value od 100% in order to get one year survival | one year after hospital release | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality |  | 30 days and 60 days after critical illness onset and one year after hospital release | 
| health related quality of life (HRQOL) | HRQOL was assessed using EQ5D-3L questionnaire | one year after hospital release | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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critical care, intensive care, health related quality of life, cost benefit analysis