Patients
|
General adult ICU population (n = 40,916), Norway 2008–2010. One or more organ failures, case mix, >90% of annual ICU admissions in the country
|
Norwegian Intensive Care Registry
|
Intervention
|
ICU admission
| |
Comparator
|
Hypothetical ICU refusal and general ward treatment of the same patients
| |
Setting
|
38 mixed medical-surgical ICUs out of a total of 42 ICUs in publicly funded hospitals operated by local health trusts under four state-owned regional health authorities.
| |
Health outcome
|
Quality-adjusted life years (QALYs)
| |
Resource use
|
Hospital costs were summed in Norwegian kroner (NOK), converted to NOK in 2016 using the CPI and to Euro (€) using OECD PPP: 1 USD = 9.4 NOK = 0.75 Euros
|
Statistics Norway, [51]
|
Severity of disease
|
Expected lifetime health if rejected to the ICU. Measured as number of lifetime QALYs.
|
[13]
|
Distribution weights
|
Higher weights assigned to health gains to patients with more severe conditions; results in more favourable cost-effectiveness estimates.
|
Additional file 2, [13, 62]
|
Perspective
|
Hospital, health care provider
|
[50]
|
Time horizon
|
Lifetime
|
[50]
|
Discounting
|
4% annually of health benefits and incremental health care costs post-hospital discharge.
|
[50]
|
Heterogeneity
|
Analysis of total study population, subgroups by type of admission and individual admissions.
| |
General cost-effectiveness threshold range
|
275,000–800,000 NOK per QALY ≈22,000–64,000 PPP-adjusted € per QALY.
|
[56, 57]
|
Model parameter
|
Parameter values
|
Sources
|
.
|
Base case
|
Range
|
Distribution
|
.
|
Age
|
Individual age
|
Individual age
|
Observed
|
ICU cohort 2008–2010
|
Transition probabilities:
| | | | |
Effect of ICU admission on hospital mortality
| | | | |
Predicted hospital mortality if ICU patient
|
Individual SAPS II, calibrated model
| |
Observed
|
ICU cohort 2008–2010, [35]
|
Predicted hospital mortality if general ward
|
Individual SAPS II, modified model (β1 = 0.09)
|
β1 = 0.0737 to 0.14
|
Scaled betaa
|
Fig. 1, Additional files 1 and 2
|
Annual mortality after hospital discharge
|
Age-specific *3–1 over 3 years
|
*1 to *5–1 over 10 years
|
Uniform
|
Life table Norway 2011, [34], Additional file 2
|
Length of hospital stay, mean (median) days
| | | | |
If ICU, weighted sum of
| | | | |
Died ICU
|
LOS ICU
|
4.8 (1.7)
|
0.6–5.0 (IQR)
|
Observed
|
ICU cohort 2008–2010
|
|
LOS ward post ICU
|
0
|
NA
|
NA
| |
Died ward
|
LOS ICU
|
5.4 (2.6)
|
1.3–5.9 (IQR)
|
Observed
|
ICU cohort 2008–2010
|
|
LOS ward post ICU
|
2.5
|
NA
|
Gamma (scale = 0.5, shape = 5)
| |
Survived hospital
|
LOS ICU
|
4.1 (2.0)
|
1.1–4.1 (IQR)
|
Observed
|
ICU cohort 2008–2010
|
|
LOS ward post ICU
|
10
|
NA
|
Gamma (scale = 2, shape = 5)
| |
If general ward, weighted sum of
| | | | |
Died hospital
|
LOS ward
|
LOS if ICU and dead *0.9
|
NA
|
Gamma
| |
Survived hospital
|
LOS ward
|
LOS if ICU and hospital survivor *1.1
|
NA
|
Gamma
| |
Cost units
| | | | |
Cost of ICU bed-day
|
€3980
|
€2390 to €5570
|
Scaled betab
|
Additional file 2, [18]
|
Cost of general ward bed-day
|
€640
|
€320 to €950
|
Scaled betab
|
Additional file 2
|
Annual health care cost survivors, year 1
|
€6400
|
€80 to €12,700
|
Scaled betab
|
[47, 48]
|
Years 2–5
|
Year 1 *0.6, *0.5, *0.4, *0.3
| | | |
Health-related quality of life weights
|
*0.8
|
*0.6 to 0.9
|
Scaled betac
|
Additional files 1 and 2, [19, 38,39,40,41,42]
|
Age-matched reference value reduced 20% for 5 years after discharge, equally for both treatment options
|
18–19: 0.90
|
0.72
|
0.54 to 0.81
| | |
20–29: 0.89
|
0.71
|
0.53 to 0.80
| | |
30–39: 0.88
|
0.70
|
0.53 to 0.79
| | |
40–49: 0.86
|
0.69
|
0.52 to 0.77
| | |
50–59: 0.84
|
0.67
|
0.50 to 0.76
| | |
60–69: 0.81
|
0.65
|
0.49 to 0.73
| | |
70–79: 0.79
|
0.63
|
0.47 to 0.71
| | |
80+: 0.73
|
0.59
|
0.44 to 0.66
| | |
Distribution weights based on lifetime QALYs
|
Linear
|
NA
|
NA
|
Additional file 2, [13, 62]
|