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The need for more efficient use of existing Intensive Care Capacity: is Short Stay IC for CABG-patients the solution? FREE TO VIEW

Ghislaine M. Van, MS*; Hans Severens, Professor; John Heijmans, doctor; Paul Roekaerts, doctor; Gemma Voss, PhD; Jos Maessen, doctor
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University Hospital of Maastricht, Maastricht, the Netherlands


Chest. 2004;126(4_MeetingAbstracts):856S. doi:10.1378/chest.126.4_MeetingAbstracts.856S
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PURPOSE:  Due to an increase of high-risk cardio-surgical patients, budget constrains,improvements in anesthetic and cardio-thoracic procedures their is a need to re-evaluate the existing IC capacity. A randomised controlled clinical equivalence trial was conducted to evaluate the safety and cost-effectiveness of Short Stay Intensive Care (SSIC) for CABG-patients.

METHODS:  For this, 600 patients were included to undergo either SSIC (< 8 hours, n=300) or a traditional IC-treatment (TICT)>16 hours, n=300). The primary endpoints were IC re-admissions and total hospital stay. The secondary endpoints were mortality, morbidity, Quality of Life (QoL) and total hospital costs. QoL was measured using the EuroQoL and expressed in Quality Adjusted Life Months (QALMs). The follow-up of the study was until one month after surgery. Incremental Cost-Effectiveness Ratio (ICER) was calculated of cost/QALMs. Bootstrap analysis were performed to quantify the uncertainty around the base case ICER. In addition to this, sensitivity analyses on costs were performed to explore the robustness of the findings.

RESULTS:  No significant differences in IC re-admissions between SSIC (n=8) and TICT (n=4) were found (p-value=.241). The total hospital stay (p-value=.807), 30 day-mortality (p-value=.317), morbidity and QALMs (95%CI: -0,004, 0,0003) were also not significantly different between the two groups. 165 (55%) patients in the SSIC-group were transferred from IC to Medium Care within 8 hours. The total hospital costs were significantly lower in the SSIC (€5.441) compared to the TICT-group (€4.625) (95% CI: € -1581, €-174). These cost savings were largely due to fewer hours of IC stay (SSICmean=19.7 and TICT mean=31.0) and fewer laboratory procedures. The ICER is (Cost/QALM) €-815/-0.00211=385.773, indicating that SSIC leads to cost savings without relevant efficacy loss. After analysing the uncertainty and performing sensitivity analysis this result still held and was proven to be very robust.

CONCLUSION:  Compared to TICT, SSIC is safe, lowers IC hours and the total hospital costs.

CLINICAL IMPLICATIONS:  Therefore it is a possible solution for a more efficient use of existing IC-capacity.

DISCLOSURE:  G.M. Van, None.

Wednesday, October 27, 2004

12:30 PM- 2:00 PM




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