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Cost-effectiveness of a paediatric retrieval service


Paediatric intensive care is expensive and accounts for a large share of inpatient expenditure. Recently, it has been claimed that not only is transfer of critically ill children best performed by specialist paediatric retrieval services (PRS) [1] but the use of such services should reduce the health care costs of these patients [2]. We report the effect a PRS has had on cost-effectiveness within the PICU, specifically: the median cost per survivor (CPS) and non-survivor (CPNS) and the effective cost per survivor (ECPS) within defined mortality risk intervals. Predicted mortality was calculated from the patients admission PRISM score, for both retrieved (R) and non-retrieved (NR) patients during the period 1 January 1994-31 December 1995. ECPS was determined by summing the total costs incurred within each mortality risk interval and dividing the sum by the total number of survivors.

Patients and methods

Guy's Hospital has a 120 bedded children's hospital, with 16 PICU beds. Each retrieval team incorporates two doctors, the lead clinician being either a Consultant or Fellow together with a resident, and one nurse. Since January 1995, the unit has had the ability to run two PRS simultaneously.


The table shows the median costs incurred for CPS and CPNS. The ECPS is also given. All costs are in pounds Sterling (£). Costs were allocated from the use of patient TISS points. The value of a TISS point in 1994 and 1995 was £34.70 and £33.80 pounds, respectively. N0 records the number of patients within each mortality risk interval and (*) denotes deaths.

The mean predicted risk, the standardised mortality ratios (all less than 1) and the median length of PICU stay (days) for NR versus R patients were not significantly different within comparable mortality risk intervals (data not shown).


We can find no supportive evidence to show that surviving patients retrieved by specialist staff do indeed have reduced health care costs; to the contrary the trend is towards them being more costly.



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Murdoch, I., Sajjanhar, T., Tibby, S. et al. Cost-effectiveness of a paediatric retrieval service . Crit Care 1 (Suppl 1), P126 (1997).

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