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Hughes N, Jia Y, Sujan M, Lawton T, Habli I, McDermid J. Contextual design requirements for decision-support tools involved in weaning patients from mechanical ventilation in intensive care units. APPLIED ERGONOMICS 2024; 118:104275. [PMID: 38574594 DOI: 10.1016/j.apergo.2024.104275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
Weaning patients from ventilation in intensive care units (ICU) is a complex task. There is a growing desire to build decision-support tools to help clinicians during this process, especially those employing Artificial Intelligence (AI). However, tools built for this purpose should fit within and ideally improve the current work environment, to ensure they can successfully integrate into clinical practice. To do so, it is important to identify areas where decision-support tools may aid clinicians, and associated design requirements for such tools. This study analysed the work context surrounding the weaning process from mechanical ventilation in ICU environments, via cognitive task and work domain analyses. In doing so, both what cognitive processes clinicians perform during weaning, and the constraints and affordances of the work environment itself, were described. This study found a number of weaning process tasks where decision-support tools may prove beneficial, and from these a set of contextual design requirements were created. This work benefits researchers interested in creating human-centred decision-support tools for mechanical ventilation that are sensitive to the wider work system.
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Affiliation(s)
- Nathan Hughes
- University of York, Deramore Lane, York, YO10 5GH, UK.
| | - Yan Jia
- University of York, Deramore Lane, York, YO10 5GH, UK
| | | | - Tom Lawton
- University of York, Deramore Lane, York, YO10 5GH, UK; Improvement Academy, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Ibrahim Habli
- University of York, Deramore Lane, York, YO10 5GH, UK
| | - John McDermid
- University of York, Deramore Lane, York, YO10 5GH, UK
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2
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Kommandantvold SA, Lemenuel-Diot A, Skedgel C, Pitman R, Rouse P, Zaraket H, Zhou H, Blanchet Zumofen MH. A cost-effectiveness analysis of reduced viral transmission with baloxavir marboxil versus oseltamivir or no treatment for seasonal and pandemic influenza management in the United Kingdom. Expert Rev Pharmacoecon Outcomes Res 2024:1-14. [PMID: 38850520 DOI: 10.1080/14737167.2024.2365421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/14/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Baloxavir marboxil is an oral, single-dose, cap-dependent endonuclease inhibitor that reduces the duration of influenza symptoms and rapidly stops viral shedding. We developed a susceptible, exposed, infected, recovered (SEIR) model to inform a cost-effectiveness model (CEM) of baloxavir versus oseltamivir or no antiviral treatment in the UK. RESEARCH DESIGN AND METHODS The SEIR model estimated the attack rates among otherwise healthy and high-risk individuals in seasonal and pandemic settings. The CEM assumed that a proportion of infected patients would receive antiviral treatment. Results were reported at the population level (per 10,000 at risk of infection). RESULTS The SEIR model estimated greater reductions in infections with baloxavir. In a seasonal setting, baloxavir provided incremental cost-effectiveness ratios (ICERs) of £1884 per quality-adjusted life-year (QALY) gained versus oseltamivir and a dominant cost-effectiveness position versus no antiviral treatment in the total population; ICERs of £2574/QALY versus oseltamivir and £128/QALY versus no antiviral treatment were seen in the high-risk population. Baloxavir was also cost-effective versus oseltamivir or no antiviral treatment and reduced population-level health system occupancy concerns during a pandemic. CONCLUSION Baloxavir treatment resulted in the fewest influenza cases and was cost-effective versus oseltamivir or no antiviral treatment from a UK National Health Service perspective.
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Affiliation(s)
| | | | | | | | | | | | - Hao Zhou
- Genentech Inc, South San Francisco, CA, USA
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Prithula J, Chowdhury MEH, Khan MS, Al-Ansari K, Zughaier SM, Islam KR, Alqahtani A. Improved pediatric ICU mortality prediction for respiratory diseases: machine learning and data subdivision insights. Respir Res 2024; 25:216. [PMID: 38783298 PMCID: PMC11118601 DOI: 10.1186/s12931-024-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/29/2024] [Indexed: 05/25/2024] Open
Abstract
The growing concern of pediatric mortality demands heightened preparedness in clinical settings, especially within intensive care units (ICUs). As respiratory-related admissions account for a substantial portion of pediatric illnesses, there is a pressing need to predict ICU mortality in these cases. This study based on data from 1188 patients, addresses this imperative using machine learning techniques and investigating different class balancing methods for pediatric ICU mortality prediction. This study employs the publicly accessible "Paediatric Intensive Care database" to train, validate, and test a machine learning model for predicting pediatric patient mortality. Features were ranked using three machine learning feature selection techniques, namely Random Forest, Extra Trees, and XGBoost, resulting in the selection of 16 critical features from a total of 105 features. Ten machine learning models and ensemble techniques are used to make accurate mortality predictions. To tackle the inherent class imbalance in the dataset, we applied a unique data partitioning technique to enhance the model's alignment with the data distribution. The CatBoost machine learning model achieved an area under the curve (AUC) of 72.22%, while the stacking ensemble model yielded an AUC of 60.59% for mortality prediction. The proposed subdivision technique, on the other hand, provides a significant improvement in performance metrics, with an AUC of 85.2% and an accuracy of 89.32%. These findings emphasize the potential of machine learning in enhancing pediatric mortality prediction and inform strategies for improved ICU readiness.
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Affiliation(s)
- Johayra Prithula
- Department of Electrical and Electronics Engineering, University of Dhaka, Dhaka, 1000, Bangladesh
| | | | | | | | - Susu M Zughaier
- Department of Basic Medical Sciences, College of Medicine, Qatar University, 2713, Doha, Qatar
| | - Khandaker Reajul Islam
- Department of Physiology, Faculty of Medicine, University Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Abdulrahman Alqahtani
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, 11942, Al-Kharj, Saudi Arabia
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, 11952, Majmaah, Saudi Arabia
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4
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Sitbon A, Hauw-Berlemont C, Mebarki M, Heming N, Mayaux J, Diehl JL, Demoule A, Annane D, Marois C, Demeret S, Weiss E, Voiriot G, Fartoukh M, Constantin JM, Mégarbane B, Plantefève G, Boucher-Pillet H, Churlaud G, Cras A, Maheux C, Pezzana C, Diallo MH, Lebbah S, Ropers J, Salem JE, Straus C, Menasché P, Larghero J, Monsel A. Treatment of COVID-19-associated ARDS with umbilical cord-derived mesenchymal stromal cells in the STROMA-CoV-2 multicenter randomized double-blind trial: long-term safety, respiratory function, and quality of life. Stem Cell Res Ther 2024; 15:109. [PMID: 38637891 PMCID: PMC11027516 DOI: 10.1186/s13287-024-03729-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The STROMA-CoV-2 study was a French phase 2b, multicenter, double-blind, randomized, placebo-controlled clinical trial that did not identify a significant efficacy of umbilical cord-derived mesenchymal stromal cells in patients with SARS-CoV-2-induced acute respiratory distress syndrome. Safety on day 28 was found to be good. The aim of our extended study was to assess the 6- and 12-month safety of UC-MSCs administration in the STROMA-CoV-2 cohort. METHODS A detailed multi-domain assessment was conducted at 6 and 12 months following hospital discharge focusing on adverse events, lung computed tomography-scan, pulmonary and muscular functional status, and quality of life in the STROMA-CoV-2 cohort including SARS-CoV-2-related early (< 96 h) mild-to-severe acute respiratory distress syndrome. RESULTS Between April 2020 and October 2020, 47 patients were enrolled, of whom 19 completed a 1-year follow-up. There were no significant differences in any endpoints or adverse effects between the UC-MSCs and placebo groups at the 6- and 12-month assessments. Ground-glass opacities persisted at 1 year in 5 patients (26.3%). Furthermore, diffusing capacity for carbon monoxide remained altered over 1 year, although no patient required oxygen or non-invasive ventilatory support. Quality of life revealed declines in mental, emotional and physical health throughout the follow-up period, and the six-minute walking distance remained slightly impaired at the 1-year patient assessment. CONCLUSIONS This study suggests a favorable safety profile for the use of intravenous UC-MSCs in the context of the first French wave of SARS-CoV-2-related moderate-to-severe acute respiratory distress syndrome, with no adverse effects observed at 1 year.
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Affiliation(s)
- Alexandre Sitbon
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Caroline Hauw-Berlemont
- Intensive Care Unit, APHP-CUP, Hôpital Européen Georges-Pompidou, Université Paris Cité, 75015, Paris, France
| | - Miryam Mebarki
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
| | - Nicholas Heming
- FHU SEPSIS, Department of Intensive Care, Hôpital Raymond-Poincaré (APHP), Laboratory of Infection & Inflammation-INSERM U1173, Simone Veil School of Medicine, University Versailles Saint Quentin-University Paris Saclay, 92380, Garches, France
| | - Julien Mayaux
- APHP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Jean-Luc Diehl
- Intensive Care Unit, APHP-CUP, Hôpital Européen Georges-Pompidou, Université Paris Cité, 75015, Paris, France
- Innovative Therapies in Hemostasis, INSERM, Université Paris Cité, 75006, Paris, France
- Biosurgical Research Laboratory (Carpentier Foundation), APHP-CUP, Hôpital Européen Georges-Pompidou, 75015, Paris, France
| | - Alexandre Demoule
- APHP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France
| | - Djillali Annane
- FHU SEPSIS, Department of Intensive Care, Hôpital Raymond-Poincaré (APHP), Laboratory of Infection & Inflammation-INSERM U1173, Simone Veil School of Medicine, University Versailles Saint Quentin-University Paris Saclay, 92380, Garches, France
| | - Clémence Marois
- Neurological Intensive Care Unit, Department of Neurology, La Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Sophie Demeret
- Neurological Intensive Care Unit, Department of Neurology, La Pitié-Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique en REanimation et Soins Intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU PARABOL, APHP Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
| | - Guillaume Voiriot
- Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Muriel Fartoukh
- Centre de Recherche Saint-Antoine UMRS_938 INSERM, Assistance Publique - Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jean-Michel Constantin
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS1144, University of Paris, Paris, France
| | - Gaëtan Plantefève
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France
| | - Hélène Boucher-Pillet
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Guillaume Churlaud
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Audrey Cras
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
- INSERM UMR1140, Université Paris Cité, 75006, Paris, France
| | - Camille Maheux
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Chloé Pezzana
- INSERM, UMR S 970, Paris Centre de Recherche Cardiovasculaire (PARCC), Université de Paris, Paris, France
| | | | - Said Lebbah
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Joe-Elie Salem
- Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance Publique - Hôpitaux de Paris (AP-HP), Clinical Investigation Center (CIC-1901), Regional Pharmacovigilance Centre, Department of Pharmacology, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Christian Straus
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, Sorbonne Université, 75013, Paris, France
| | - Philippe Menasché
- INSERM UMR1140, Université Paris Cité, 75006, Paris, France
- Department of Cardiovascular Surgery, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jérôme Larghero
- APHP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CBT501, INSERM, Université Paris Cité, Paris, France
- Centre MEARY de Thérapie Cellulaire et Génique, APHP, Hôpital Saint-Louis, Paris, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology-Critical Care and Perioperative Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (APHP) Sorbonne University, 47-83, boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
- INSERM UMRS_959, Immunology-Immunopathology-Immunotherapy (I3), Sorbonne Université, 75013, Paris, France.
- Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, APHP, 75651, Paris, France.
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Szymczak H, Dodoo-Schittko F, Brandstetter S, Rohr M, Blecha S, Bein T, Apfelbacher CJ. Health Care Utilization in ARDS Survivors 2-3 Years After Discharge. Respir Care 2023; 68:676-679. [PMID: 37015813 PMCID: PMC10171342 DOI: 10.4187/respcare.10478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Hermann Szymczak
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Frank Dodoo-Schittko
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Susanne Brandstetter
- Medical Sociology, University of Regensburg, Regensburg, Germany
- University Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Magdalena Rohr
- Medical Sociology, University of Regensburg, Regensburg, Germany
- University Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Sebastian Blecha
- Department for Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Bein
- Medical Faculty, University of Regensburg, Regensburg, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Medical Sociology, University of Regensburg, Regensburg, Germany
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Bernard A, Serna-Higuita LM, Martus P, Mirakaj V, Koeppen M, Zarbock A, Marx G, Putensen C, Rosenberger P, Haeberle HA. COVID-19 does not influence functional status after ARDS therapy. Crit Care 2023; 27:48. [PMID: 36740717 PMCID: PMC9899507 DOI: 10.1186/s13054-023-04330-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Health-related quality of life after surviving acute respiratory distress syndrome has come into focus in recent years, especially during the coronavirus disease 2019 pandemic. OBJECTIVES A total of 144 patients with acute respiratory distress syndrome caused by COVID-19 or of other origin were recruited in a randomized multicenter trial. METHODS Clinical data during intensive care treatment and data up to 180 days after study inclusion were collected. Changes in the Sequential Organ Failure Assessment score were used to quantify disease severity. Disability was assessed using the Barthel index on days 1, 28, 90, and 180. MEASUREMENTS Mortality rate and morbidity after 180 days were compared between patients with and without COVID-19. Independent risk factors associated with high disability were identified using a binary logistic regression. MAIN RESULTS The SOFA score at day 5 was an independent risk factor for high disability in both groups, and score dynamic within the first 5 days significantly impacted disability in the non-COVID group. Mortality after 180 days and impairment measured by the Barthel index did not differ between patients with and without COVID-19. CONCLUSIONS Resolution of organ dysfunction within the first 5 days significantly impacts long-term morbidity. Acute respiratory distress syndrome caused by COVID-19 was not associated with increased mortality or morbidity.
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Affiliation(s)
- Alice Bernard
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Lina Maria Serna-Higuita
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- grid.10392.390000 0001 2190 1447Institute for Clinical Epidemiology and Applied Biometry, Faculty of Medicine, University of Tübingen, Tübingen, Germany
| | - Valbona Mirakaj
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Michael Koeppen
- grid.411544.10000 0001 0196 8249Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Alexander Zarbock
- grid.5949.10000 0001 2172 9288Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany
| | - Gernot Marx
- grid.412301.50000 0000 8653 1507Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Putensen
- grid.15090.3d0000 0000 8786 803XDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
| | - Helene Anna Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
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Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study): A Multicenter Observational Study. J Clin Med 2023; 12:jcm12031058. [PMID: 36769705 PMCID: PMC9918008 DOI: 10.3390/jcm12031058] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. METHODS In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. RESULTS Among 1003 patients screened, 343 (median age 63 years [57-70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2-20]. Physical functioning (PF 85 [60-95]), physical role (PR 75 [0-100]), emotional role (RE 100 [33-100]), bodily pain (BP 77.5 [45-100]), social functioning (SF 75 [50-100]), general health (GH 55 [35-72]), vitality (VT 55 [40-70]), mental health (MH 68 [52-84]) and health change (HC 50 [25-75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5-53.5) and 51.7 (48.8-54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). CONCLUSIONS The HRQoL in COVID-19 ARDS (C-ARDS) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of them. Further research is warranted to better identify the possible factors affecting the HRQoL in C-ARDS.
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Gandjour A. COVID-19 and the forgone health benefits of elective operations. BMC Health Serv Res 2022; 22:1545. [PMID: 36528629 PMCID: PMC9759364 DOI: 10.1186/s12913-022-08956-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIM The first SARS-CoV-2 pandemic wave in Germany involved a tradeoff between saving the lives of COVID-19 patients by providing sufficient intensive care unit (ICU) capacity and foregoing the health benefits of elective procedures. This study aims to quantify this tradeoff. METHODS The analysis is conducted at both the individual and population levels. The analysis calculates quality-adjusted life years (QALYs) to facilitate a comparison between the health gains from saving the lives of COVID-19 patients in the ICU and the health losses associated with postponing operative procedures. The QALYs gained from saving the lives of COVID-19 patients are calculated based on both the real-world ICU admissions and deaths averted from flattening the first wave. Scenario analysis was used to account for variation in input factors. RESULTS At the individual level, the resource-adjusted QALY gain of saving one COVID-19 life is predicted to be 3 to 15 times larger than the QALY loss of deferring one operation (the average multiplier is 9). The real-world QALY gain at the population level is estimated to fall within the range of the QALY loss due to delayed procedures. The modeled QALY gain by flattening the first wave is 3 to 31 times larger than the QALY loss due to delayed procedures (the average multiplier is 17). CONCLUSION During the first wave of the pandemic, the resource-adjusted health gain from treating one COVID-19 patient in the ICU was found to be much larger than the health loss from deferring one operation. At the population level, flattening the first wave led to a much larger health gain than the health loss from delaying operative procedures.
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Affiliation(s)
- Afschin Gandjour
- grid.461612.60000 0004 0622 3862Frankfurt School of Finance & Management, Adickesallee 32-34, 60322 Frankfurt am Main, Germany
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9
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Mayer KP, Palakshappa JA, Peltan ID, Andrew JS, Gundel SJ, Ringwood NJ, Mckeehan J, Hope AA, Rogers AJ, Biehl M, Hayden DL, Caldwell E, Mehkri O, Lynch DJ, Burham EL, Hough CL, Jolley SE. Functional, imaging, and respiratory evaluation (FIRE) of patients post-hospitalization for COVID-19: protocol for a pilot observational study. Pilot Feasibility Stud 2022; 8:212. [PMID: 36123599 PMCID: PMC9483889 DOI: 10.1186/s40814-022-01151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/12/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction We describe a protocol for FIRE CORAL, an observational cohort study that examines the recovery from COVID-19 disease following acute hospitalization with an emphasis on functional, imaging, and respiratory evaluation. Methods and analysis FIRE CORAL is a multicenter prospective cohort study of participants recovering from COVID-19 disease with in-person follow-up for functional and pulmonary phenotyping conducted by the National Heart, Lung and Blood Institute (NHLBI) Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. FIRE CORAL will include a subset of participants enrolled in Biology and Longitudinal Epidemiology of PETAL COVID-19 Observational Study (BLUE CORAL), an NHLBI-funded prospective cohort study describing the clinical characteristics, treatments, biology, and outcomes of hospitalized patients with COVID-19 across the PETAL Network. FIRE CORAL consists of a battery of in-person assessments objectively measuring pulmonary function, abnormalities on lung imaging, physical functional status, and biospecimen analyses. Participants will attend and perform initial in-person testing at 3 to 9 months after hospitalization. The primary objective of the study is to determine the feasibility of longitudinal assessments investigating multiple domains of recovery from COVID-19. Secondarily, we will perform descriptive statistics, including the prevalence and characterization of abnormalities on pulmonary function, chest imaging, and functional status. We will also identify potential clinical and biologic factors that predict recovery or the occurrence of persistent impairment of pulmonary function, chest imaging, and functional status. Ethics and dissemination FIRE CORAL is approved via the Vanderbilt University central institutional review board (IRB) and via reliance agreement with the site IRBs. Results will be disseminated via the writing group for the protocol committee and reviewed by the PETAL Network publications committee prior to publication. Data obtained via the study will subsequently be made publicly available via NHLBI’s biorepository. Strengths and limitations of the study Strengths:First US-based multicenter cohort of pulmonary and functional outcomes in patients previously hospitalized for COVID-19 infection Longitudinal biospecimen measurement allowing for biologic phenotyping of abnormalities Geographically diverse cohort allowing for a more generalizable understanding of post-COVID pulmonary sequela
Limitations:Selected cohort given proximity to a participating center Small cohort which may be underpowered to identify small changes in pulmonary function
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Affiliation(s)
- Kirby P Mayer
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Department of Physical Therapy, University of Kentucky, Lexington, USA
| | - Jessica A Palakshappa
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Ithan Daniel Peltan
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Intermountain Healthcare, Salt Lake City, USA
| | - James S Andrew
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Division of Rheumatology, University of Washington, Seattle, USA
| | - Stephanie J Gundel
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,University of Washington, Seattle, USA
| | - Nancy J Ringwood
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Massachusetts General Hospital, Boston, USA
| | - Jeffrey Mckeehan
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Aluko A Hope
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, USA
| | - Angela J Rogers
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Pulmonary and Critical Care Medicine, Stanford University, Stanford, USA
| | - Michelle Biehl
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Critical Care Medicine, Cleveland Clinic, Cleveland, USA
| | - Douglas L Hayden
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Massachusetts General Hospital, Boston, USA
| | - Ellen Caldwell
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Division of Pulmonary and Critical Care, University of Washington, Seattle, USA
| | - Omar Mehkri
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, USA
| | - David J Lynch
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Department of Radiology, National Jewish Health, Denver, USA
| | - Ellen L Burham
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.,Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, USA
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.
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10
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Hernández-Cuervo H, Soundararajan R, Sidramagowda Patil S, Breitzig M, Alleyn M, Galam L, Lockey R, Uversky VN, Kolliputi N. BMI1 Silencing Induces Mitochondrial Dysfunction in Lung Epithelial Cells Exposed to Hyperoxia. Front Physiol 2022; 13:814510. [PMID: 35431986 PMCID: PMC9005903 DOI: 10.3389/fphys.2022.814510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Acute Lung Injury (ALI), characterized by bilateral pulmonary infiltrates that restrict gas exchange, leads to respiratory failure. It is caused by an innate immune response with white blood cell infiltration of the lungs, release of cytokines, an increase in reactive oxygen species (ROS), oxidative stress, and changes in mitochondrial function. Mitochondrial alterations, changes in respiration, ATP production and the unbalancing fusion and fission processes are key events in ALI pathogenesis and increase mitophagy. Research indicates that BMI1 (B cell-specific Moloney murine leukemia virus integration site 1), a protein of the Polycomb repressive complex 1, is a cell cycle and survival regulator that plays a role in mitochondrial function. BMI1-silenced cultured lung epithelial cells were exposed to hyperoxia to determine the role of BMI1 in mitochondrial metabolism. Its expression significantly decreases in human lung epithelial cells (H441) following hyperoxic insult, as determined by western blot, Qrt-PCR, and functional analysis. This decrease correlates with an increase in mitophagy proteins, PINK1, Parkin, and DJ1; an increase in the expression of tumor suppressor PTEN; changes in the expression of mitochondrial biomarkers; and decreases in the oxygen consumption rate (OCR) and tricarboxylic acid enzyme activity. Our bioinformatics analysis suggested that the BMI1 multifunctionality is determined by its high level of intrinsic disorder that defines the ability of this protein to bind to numerous cellular partners. These results demonstrate a close relationship between BMI1 expression and mitochondrial health in hyperoxia-induced acute lung injury (HALI) and indicate that BMI1 is a potential therapeutic target to treat ALI and Acute Respiratory Distress Syndrome.
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Affiliation(s)
- Helena Hernández-Cuervo
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ramani Soundararajan
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Sahebgowda Sidramagowda Patil
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Mason Breitzig
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Division of Epidemiology, Department of Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Matthew Alleyn
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Lakshmi Galam
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Richard Lockey
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Vladimir N. Uversky
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Narasaiah Kolliputi
- Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Department of Molecular Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- *Correspondence: Narasaiah Kolliputi,
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11
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Schmidt KFR, Huelle K, Reinhold T, Prescott HC, Gehringer R, Hartmann M, Lehmann T, Mueller F, Reinhart K, Schneider N, Schroevers MJ, Kosilek RP, Vollmar HC, Heintze C, Gensichen JS. Healthcare Utilization and Costs in Sepsis Survivors in Germany-Secondary Analysis of a Prospective Cohort Study. J Clin Med 2022; 11:jcm11041142. [PMID: 35207415 PMCID: PMC8879304 DOI: 10.3390/jcm11041142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.
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Affiliation(s)
- Konrad F. R. Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
- Correspondence: or ; Tel.: +49-3641-9395800 or +49-30-450-514-133; Fax: +49-3641-9395802 or +49-30-450-514-932
| | - Katharina Huelle
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine, D-10117 Berlin, Germany;
| | - Hallie C. Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-5368, USA;
- VA Center for Clinical Management Research, Ann Arbor, MI 48105, USA
| | - Rebekka Gehringer
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
| | - Michael Hartmann
- Hospital Pharmacy, Jena University Hospital, D-07747 Jena, Germany;
| | - Thomas Lehmann
- Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, D-07747 Jena, Germany;
| | - Friederike Mueller
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Thiem-Research GmbH, Carl-Thiem-Klinikum, D-03048 Cottbus, Germany;
| | - Konrad Reinhart
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, D-10117 Berlin, Germany;
| | - Nico Schneider
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, D-07743 Jena, Germany;
| | - Maya J. Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB Groningen, The Netherlands;
| | - Robert P. Kosilek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
| | - Horst C. Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Department of Family Medicine, Ruhr-University Bochum Medical School, D-44801 Bochum, Germany;
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany;
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany; (K.H.); (R.G.)
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany; (R.P.K.); (J.S.G.)
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12
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Gandjour A. Benefits, risks, and cost-effectiveness of COVID-19 self-tests from a consumer's perspective. BMC Health Serv Res 2022; 22:47. [PMID: 35000587 PMCID: PMC8743237 DOI: 10.1186/s12913-021-07277-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to quantify the health benefits, risks, and cost-effectiveness of COVID-19 self-tests from a consumer's perspective in Germany. METHODS The analysis is based on a modelling approach using secondary data. The clinical endpoints considered in this analysis are avoided SARS-CoV-2 infections and secondary severe clinical events (death, intensive care unit (ICU) admission, and long COVID syndrome). The study determines the number of self-tests that need to be conducted under a 7-day incidence of 75 per 100,000 population to prevent one infection or severe clinical event. Furthermore, the study calculates the cost of testing per avoided clinical event and quality-adjusted life year (QALY) gained from a consumer perspective. RESULTS Disregarding the rate of unreported COVID-19 cases, 4556 self-tests need to be conducted (over 12 years) in order to avoid one undesirable event (death, intensive care unit stay, or long COVID syndrome). Ninety percent of infections are not avoided among direct contacts but along the chain of infection. The costs per quality-adjusted life year gained from a consumer's perspective are €5870. This ratio is particularly sensitive to the 7-day incidence, effective reproduction number, and the age of contacts. CONCLUSIONS The benefits of self-testing in the general population at a 7-day incidence rate of 75 per 100,000 appear to be minor. Nevertheless, cost-effectiveness may still be acceptable in the presence of higher-risk contacts given the low costs of self-test kits in Germany.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance & Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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13
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Javanbakht M, Moradi-Lakeh M, Mashayekhi A, Atkinson J. Continuous Monitoring of Respiratory Rate with Wearable Sensor in Patients Admitted to Hospital with Pneumonia Compared with Intermittent Nurse-Led Monitoring in the United Kingdom: A Cost-Utility Analysis. PHARMACOECONOMICS - OPEN 2022; 6:73-83. [PMID: 34387850 PMCID: PMC8363094 DOI: 10.1007/s41669-021-00290-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Respiratory rate (RR) is one of the most important physiologic measures for predicting patients' deterioration of clinical condition and final prognosis. In several studies, RR has been the most important predictor of patients' prognoses. OBJECTIVES The objective of this study was to conduct a cost-utility analysis to estimate the cost and effectiveness of automatic respiratory rate monitoring (ARRM) with a non-invasive sensor (RespiraSense™) plus intermittent nurse-led RR monitoring (ARRM strategy) compared with intermittent nurse-led RR monitoring (IM strategy) in patients admitted to hospital in the UK with pneumonia. METHODS A decision analytic model was developed based on a hypothetical cohort of patients who were admitted to hospital with pneumonia. After admission, the patients could be monitored with either ARRM or IM strategies. The outcomes of interest included total costs and total effectiveness of each strategy, including length of stay (LoS) in hospital, LoS in intensive care unit, quality-adjusted life-years (QALYs), deaths, and incremental cost per QALY gained. An incremental cost of £20,000 or less per QALY gained was considered cost effective. A lifetime time horizon (38 years) was used to capture the long-term benefits. Probabilistic and deterministic sensitivity analyses were performed. RESULTS Total costs of patient care in ARRM and IM strategies were £1986.9 million and £2079.4 million, respectively. Total incremental QALYs lived were 3548 higher in the intervention arm (ARRM), meaning that the ARRM strategy was dominant (i.e., less costly [£92.6 million less] and more effective). The results were stable in probabilistic and most of the deterministic sensitivity analyses. Results from threshold analysis indicated that a minimum of 7 and 10% improvement in percentage of early detection of respiratory compromise is required for ARRM to become cost effective and cost saving, respectively. CONCLUSIONS Our results indicate that ARRM using RespiraSense, in addition to intermittent nurse-led monitoring of RR, in patients admitted to the hospital with pneumonia could be a cost-saving and cost-effective intervention if the minimum clinical thresholds are met.
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Affiliation(s)
- Mehdi Javanbakht
- Optimax Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth Hampshire, UK
| | | | - Atefeh Mashayekhi
- Optimax Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth Hampshire, UK
| | - Jowan Atkinson
- Device Access UK Ltd, Market Access Consultancy, University of Southampton Science Park, Chilworth, Hampshire, UK
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14
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Zhang Q, Wang Z, Zhu J, Peng Z, Tang C. Ferulic acid regulates miR-17/PTEN axis to inhibit LPS-induced pulmonary microvascular endothelial cells apoptosis through activation of PI3K/Akt pathway. J Toxicol Sci 2022; 47:61-69. [PMID: 35110471 DOI: 10.2131/jts.47.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Qinqin Zhang
- Department of Critical Care Medicine, Nantong Hospital of Traditional Chinese Medicine, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, China
| | - Zhilan Wang
- Department of Critical Care Medicine, Nantong Hospital of Traditional Chinese Medicine, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, China
| | - Jinfei Zhu
- Department of pneumology, Nantong Hospital of Traditional Chinese Medicine, Nantong Hospital Affiliated to Nanjing University of Chinese Medicine, China
| | - Zhili Peng
- Department of Critical Care Medicine, Rugao Hospital of Traditional Chinese Medicine, China
| | - Cheng Tang
- Department of Critical Care Medicine, The Affiliated Suqian First People's Hospital of Nanjing Medical University, China
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15
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Martin C, Luteijn M, Letton W, Robertson J, McDonald S. A model framework for projecting the prevalence and impact of Long-COVID in the UK. PLoS One 2021; 16:e0260843. [PMID: 34855874 PMCID: PMC8639065 DOI: 10.1371/journal.pone.0260843] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
The objective of this paper is to model lost Quality Adjusted Life Years (QALYs) from symptoms arising from COVID-19 disease in the UK population, including symptoms of ‘long-COVID’. The scope includes QALYs lost to symptoms, but not deaths, due to acute COVID-19 and long-COVID. The prevalence of symptomatic COVID-19, encompassing acute symptoms and long-COVID symptoms, was modelled using a decay function. Permanent injury as a result of COVID-19 infection, was modelled as a fixed prevalence. Both parts were combined to calculate QALY loss due to COVID-19 symptoms. Assuming a 60% final attack rate for SARS-CoV-2 infection in the population, we modelled 299,730 QALYs lost within 1 year of infection (90% due to symptomatic COVID-19 and 10% permanent injury) and 557,764 QALYs lost within 10 years of infection (49% due to symptomatic COVID-19 and 51% due to permanent injury). The UK Government willingness-to-pay to avoid these QALY losses would be £17.9 billion and £32.2 billion, respectively. Additionally, 90,143 people were subject to permanent injury from COVID-19 (0.14% of the population). Given the ongoing development in information in this area, we present a model framework for calculating the health economic impacts of symptoms following SARS-CoV-2 infection. This model framework can aid in quantifying the adverse health impact of COVID-19, long-COVID and permanent injury following COVID-19 in society and assist the proactive management of risk posed to health. Further research is needed using standardised measures of patient reported outcomes relevant to long-COVID and applied at a population level.
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Affiliation(s)
- Chris Martin
- UCL Institute of Health Informatics, London, United Kingdom
- * E-mail:
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16
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Zangrillo A, Belletti A, Palumbo D, Calvi MR, Guzzo F, Fominskiy EV, Ortalda A, Nardelli P, Ripa M, Baiardo Redaelli M, Borghi G, Landoni G, D'Amico F, Marmiere M, Righetti B, Rocchi M, Saracino M, Tresoldi M, Dagna L, De Cobelli F. One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation. J Cardiothorac Vasc Anesth 2021; 36:1354-1363. [PMID: 34973891 PMCID: PMC8626145 DOI: 10.1053/j.jvca.2021.11.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022]
Abstract
Objectives Patients with COVID-19 frequently develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. Data on long-term survival of these patients are lacking. The authors investigated 1-year survival, quality of life, and functional recovery of patients with COVID-19 ARDS requiring invasive mechanical ventilation. Design Prospective observational study. Setting Tertiary-care university hospital. Participants All patients with COVID-19 ARDS receiving invasive mechanical ventilation and discharged alive from hospital. Interventions Patients were contacted by phone after 1 year. Functional, cognitive, and psychological outcomes were explored through a questionnaire and assessed using validated scales. Patients were offered the possibility to undergo a follow-up chest computed tomography (CT) scan. Measurements and Main Results The study included all adult (age ≥18 years) patients with COVID-19–related ARDS admitted to an ICU of the authors’ institution between February 25, 2020, and April 27, 2020, who received at least 1 day of invasive mechanical ventilation (IMV). Of 116 patients who received IMV, 61 (52.6%) survived to hospital discharge. These survivors were assessed 1 year after discharge and 56 completed a battery of tests of cognition, activities of daily living, and interaction with family members. They had overall good functional recovery, with >80% reporting good recovery and no difficulties in usual activities. A total of 52 (93%) of patients had no dyspnea at rest. Severe anxiety/depression was reported by 5 (8.9%) patients. Comparing 2-month and 1-year data, the authors observed the most significant improvements in the areas of working status and exertional dyspnea. One-year chest CT scans were available for 36 patients; fibrotic-like changes were present in 4 patients. Conclusions All patients who survived the acute phase of COVID-19 and were discharged from the hospital were alive at the 1-year follow up, and the vast majority of them had good overall recovery and quality of life.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Righetti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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The Cost of ARDS: A Systematic Review. Chest 2021; 161:684-696. [PMID: 34478719 DOI: 10.1016/j.chest.2021.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND ARDS is an inflammatory condition of the lungs and is a common condition in adult ICUs. The resources required and costs of care for patients with ARDS are significant because of the severity of the illness and extended ICU lengths of stay. RESEARCH QUESTION What are the costs associated with ARDS? STUDY DESIGN AND METHODS We systematically searched the literature through April 29, 2021, for articles relevant to ARDS and costs. MEDLINE, Embase, Central, and EconLit databases were searched, and articles that reported on cost data from an original publication in adult patients with ARDS were included. Two authors independently assessed articles for inclusion and extracted data elements related to costs, methodology, health-care system type, economic perspective, and clinical data. Publication quality was assessed using a modified version of the Quality of Health Economic Studies Instrument. RESULTS Four thousand six hundred sixty-three publications were found, of which 110 were included for full-text review (κ = 0.72). A total of 22 publications (49,483 patients) were suitable for data extraction. The publications represented a broad range of health-care systems, economic perspectives, costing methodology, and time frames. Mean inpatient costs ranged from $8,476 (2021 US dollars [USD]) to $547,974 (2021 USD) and were highest in publications of lower quality and in American health systems and were associated with trauma cohorts. Outpatient costs were highest in publications with higher readmission rates, longer durations of follow-up, and in American health systems. INTERPRETATION A wide range of costing data is available for ARDS. A comprehensive synthesis of this literature frames the reasons for this and allows estimates to reflect the context in which they were assessed. This information will be of value to researchers and administrators interested in the economics of caring for patients with ARDS. TRIAL REGISTRY PROSPERO; No.: CRD42020192487.
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18
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Sayed M, Riaño D, Villar J. Predicting Duration of Mechanical Ventilation in Acute Respiratory Distress Syndrome Using Supervised Machine Learning. J Clin Med 2021; 10:jcm10173824. [PMID: 34501270 PMCID: PMC8432117 DOI: 10.3390/jcm10173824] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Acute respiratory distress syndrome (ARDS) is an intense inflammatory process of the lungs. Most ARDS patients require mechanical ventilation (MV). Few studies have investigated the prediction of MV duration over time. We aimed at characterizing the best early scenario during the first two days in the intensive care unit (ICU) to predict MV duration after ARDS onset using supervised machine learning (ML) approaches. Methods: For model description, we extracted data from the first 3 ICU days after ARDS diagnosis from patients included in the publicly available MIMIC-III database. Disease progression was tracked along those 3 ICU days to assess lung severity according to Berlin criteria. Three robust supervised ML techniques were implemented using Python 3.7 (Light Gradient Boosting Machine (LightGBM); Random Forest (RF); and eXtreme Gradient Boosting (XGBoost)) for predicting MV duration. For external validation, we used the publicly available multicenter database eICU. Results: A total of 2466 and 5153 patients in MIMIC-III and eICU databases, respectively, received MV for >48 h. Median MV duration of extracted patients was 6.5 days (IQR 4.4–9.8 days) in MIMIC-III and 5.0 days (IQR 3.0–9.0 days) in eICU. LightGBM was the best model in predicting MV duration after ARDS onset in MIMIC-III with a root mean square error (RMSE) of 6.10–6.41 days, and it was externally validated in eICU with RMSE of 5.87–6.08 days. The best early prediction model was obtained with data captured in the 2nd day. Conclusions: Supervised ML can make early and accurate predictions of MV duration in ARDS after onset over time across ICUs. Supervised ML models might have important implications for optimizing ICU resource utilization and high acute cost reduction of MV.
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Affiliation(s)
- Mohammed Sayed
- Department of Computer Engineering, Universitat Rovira i Virgili, Av. Paisos Catalans 26, 43007 Tarragona, Spain; (M.S.); (D.R.)
| | - David Riaño
- Department of Computer Engineering, Universitat Rovira i Virgili, Av. Paisos Catalans 26, 43007 Tarragona, Spain; (M.S.); (D.R.)
| | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrín, Barranco de la Ballena s/n, 4th Floor-South Wing, 35019 Las Palmas de Gran Canaria, Spain
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 38 Shuter St., Toronto, ON M5B 1A6, Canada
- Correspondence:
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Kotani T, Sugiyama M, Matsuzaki F, Kubodera K, Saito J, Kaneki M, Shono A, Maruo H, Mori M, Ohta S, Kasai F. Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study. J Clin Med 2021; 10:jcm10132941. [PMID: 34209010 PMCID: PMC8267911 DOI: 10.3390/jcm10132941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate the prevalence of persistent symptoms three months after discharge from the intensive care unit by checking the medical records. All patients received an early mobilization program. Four out of 13 patients (31%) had postintensive care syndrome. No patients had muscle weakness, and 11 patients (85%) returned to their previous work. However, psychiatric disorder, such as anxiety (23%) and posttraumatic stress disorder (15%), were observed. Eleven patients claimed persistent symptoms, including fatigue and numbness in the extremities. Our results suggest that the implementation of an early rehabilitation program plays some role in preventing muscle weakness and that decreasing psychiatric disorders should be a next target of patient care in the intensive care unit.
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Affiliation(s)
- Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
- Correspondence: ; Tel.: +81-3-3784-8575
| | - Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
| | - Fumika Matsuzaki
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Kota Kubodera
- Rehabilitation Center, Showa University Hospital, Tokyo 142-8666, Japan; (F.M.); (K.K.)
| | - Jin Saito
- Graduate School of Nursing and Rehabilitation Sciences, Showa University, Yokohama 226-8555, Japan;
| | - Mika Kaneki
- Department of Nutrition, Showa University Hospital, Tokyo 142-8666, Japan;
| | - Atsuko Shono
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Hiroko Maruo
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Maiko Mori
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (A.S.); (H.M.); (M.M.)
| | - Shin Ohta
- Department of Internal Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan;
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan; (M.S.); (F.K.)
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20
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Prediction of weaning from mechanical ventilation using Convolutional Neural Networks. Artif Intell Med 2021; 117:102087. [PMID: 34127233 DOI: 10.1016/j.artmed.2021.102087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
Weaning from mechanical ventilation covers the process of liberating the patient from mechanical support and removing the associated endotracheal tube. The management of weaning from mechanical ventilation comprises a significant proportion of the care of critically ill intubated patients in Intensive Care Units (ICUs). Both prolonged dependence on mechanical ventilation and premature extubation expose patients to an increased risk of complications and increased health care costs. This work aims to develop a decision support model using routinely-recorded patient information to predict extubation readiness. In order to do so, we have deployed Convolutional Neural Networks (CNN) to predict the most appropriate treatment action in the next hour for a given patient state, using historical ICU data extracted from MIMIC-III. The model achieved 86% accuracy and 0.94 area under the receiver operating characteristic curve (AUC-ROC). We also performed feature importance analysis for the CNN model and interpreted these features using the DeepLIFT method. The results of the feature importance assessment show that the CNN model makes predictions using clinically meaningful and appropriate features. Finally, we implemented counterfactual explanations for the CNN model. This can help clinicians understand what feature changes for a particular patient would lead to a desirable outcome, i.e. readiness to extubate.
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21
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Ethgen O, Goldstein J, Harenski K, Mekontso Dessap A, Morimont P, Quintel M, Combes A. A preliminary cost-effectiveness analysis of lung protective ventilation with extra corporeal carbon dioxide removal (ECCO 2R) in the management of acute respiratory distress syndrome (ARDS). J Crit Care 2021; 63:45-53. [PMID: 33618281 PMCID: PMC7972812 DOI: 10.1016/j.jcrc.2021.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
Background Mechanical ventilation (MV) is the cornerstone in the management of the acute respiratory distress syndrome (ARDS). Recent research suggests that decreasing the intensity of MV using lung protective ventilation (LPV) with lower tidal volume (Vt) and driving pressure (∆P) could improve survival. Extra-corporal CO2 removal (ECCO2R) precisely enables LPV by allowing lower Vt, ∆P and mechanical power while maintaining PaCO2 within a physiologic range. This study evaluates the potential cost-effectiveness of ECCO2R-enabled LPV in France. Methods We modelled the distribution over time of ventilated ARDS patients across 3 health-states (alive & ventilated, alive & weaned from ventilation, dead). We compared the outcomes of 3 strategies: MV (no ECCO2R), LPV (ECCO2R when PaCO2 > 55 mmHg) and Ultra-LPV (ECCO2R for all). Patients characteristics, ventilation settings, survival and lengths of stay were derived from a large ARDS epidemiology study. Survival benefits associated with lower ∆P were taken from the analysis of more than 3000 patients enrolled in 9 randomized trials. Health outcomes were expressed in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were computed with both Day 60 cost and Lifetime cost. Results Both LPV and ULPV as enabled by ECCO2R provided favorable results at Day 60 as compared to MV. Survival rates were increased with the protective strategies, notably with ULPV that provided even more manifest benefits as compared to MV. LPV and ULPV produced +0.162 and + 0.627 incremental QALYs as compared to MV, respectively. LPV and ULPV costs were augmented because of their survival benefits. Nonetheless, ICERs of LPV and ULPV vs. MV were all well below the €50,000 threshold. ULPV also presented with favorable ICERs as compared to LPV (i.e. less than €25,000/QALY). Conclusions ECCO2R-enabled LPV strategies might provide cost-effective survival benefit. Additional data from interventional and observational studies are needed to support this preliminary model-based analysis.
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Affiliation(s)
- Oliver Ethgen
- SERFAN Innovation, Namur, Belgium; Department of Public Health, Epidemiology & Health Economics, University of Liège, Liège, Belgium.
| | | | - Kai Harenski
- Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Armand Mekontso Dessap
- UPEC, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS, Créteil F-94010, France; APHP, Hôpitaux Universitaires Henri Mondor, Service de Médecine Intensive Réanimation, Créteil F-94010, France
| | - Philippe Morimont
- GIGA-Laboratory of Critical Care Basic Sciences, University of Liège, Liège, Belgium
| | - Michael Quintel
- Department of Anaesthesia and Intensive Care Medicine, University of Göttingen Medical Center Von-Siebold-Straße 3, 37075 Göttingen, Germany
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardio Metabolism and Nutrition, F-75013 Paris, France; Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France
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22
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Sangla F, Legouis D, Marti PE, Sgardello SD, Brebion A, Saint-Sardos P, Adda M, Lautrette A, Pereira B, Souweine B. One year after ICU admission for severe community-acquired pneumonia of bacterial, viral or unidentified etiology. What are the outcomes? PLoS One 2020; 15:e0243762. [PMID: 33315946 PMCID: PMC7735561 DOI: 10.1371/journal.pone.0243762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Multiplex polymerase chain reaction (mPCR) for respiratory virus testing is increasingly used in community-acquired pneumonia (CAP), however data on one-year outcome in intensive care unit (ICU) patients with reference to the causative pathogen are scarce. MATERIALS AND METHODS We performed a single-center retrospective study in 123 ICU patients who had undergone respiratory virus testing for CAP by mPCR and with known one-year survival status. Functional status including dyspnea (mMRC score), autonomy (ADL Katz score) and need for new home-care ventilatory support was assessed at a one-year post-ICU follow-up. Mortality rates and functional status were compared in patients with CAP of a bacterial, viral or unidentified etiology one year after ICU admission. RESULTS The bacterial, viral and unidentified groups included 19 (15.4%), 37 (30.1%), and 67 (54.5%) patients, respectively. In multivariate analysis, one-year mortality in the bacterial group was higher compared to the viral group (HR 2.92, 95% CI 1.71-7.28, p = 0.02) and tended to be higher compared to the unidentified etiology group (p = 0.06); but no difference was found between the viral and the unidentified etiology group (p = 0.43). In 64/83 one-year survivors with a post-ICU follow-up consultation, there were no differences in mMRC score, ADL Katz score and new home-care ventilatory support between the groups (p = 0.52, p = 0.37, p = 0.24, respectively). Severe dyspnea (mMRC score = 4 or death), severe autonomy deficiencies (ADL Katz score ≤ 2 or death), and major adverse respiratory events (new home-care ventilatory support or death) were observed in 52/104 (50.0%), 47/104 (45.2%), and 65/104 (62.5%) patients, respectively; with no difference between the bacterial, viral and unidentified group: p = 0.58, p = 0.06, p = 0.61, respectively. CONCLUSIONS CAP of bacterial origin had a poorer outcome than CAP of viral or unidentified origin. At one-year, impairment of functional status was frequently observed, with no difference according to the etiology.
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Affiliation(s)
- Frédéric Sangla
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
- * E-mail:
| | - David Legouis
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pierre-Emmanuel Marti
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sebastian D. Sgardello
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Amélie Brebion
- Laboratoire de Virologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Pierre Saint-Sardos
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Mireille Adda
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bruno Pereira
- Département de Biostatistique, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
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23
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Blecha S, Weber-Carstens S, Bein T. [Health services research in intensive care medicine in Germany : Status quo and future challenges exemplified by acute pulmonary failure]. Anaesthesist 2020; 68:343-352. [PMID: 31101923 DOI: 10.1007/s00101-019-0602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Health services research (HSR) is a multidisciplinary field of research that describes disease treatment and health care and their framework conditions. In the last 20 years, the HSR aspect became more and more the clinical focus of intensive care medicine. Under this aspect HSR investigates the use of clinical measures and their impact on patient outcome under routine intensive care medical conditions. This article provides an overview of the current state of HSR in intensive care medicine in Germany using the example of acute respiratory distress syndrome (ARDS). The ARDS still represents a clinical disease with high intra-hospital mortality (30-60%) despite progress in intensive care medicine. Survivors of ARDS have substantial long-term limitations on physical and mental health. The treatment of ARDS patients is tedious, laborious for intensive care unit staff and complex. Despite evident treatment recommendations, these are only insufficiently implemented in the clinical routine. With the help of quality indicators, benchmarking, certification and peer review procedures, the quality of intensive care treatment in the clinical routine can be documented and improved. An important role in HSR is patient safety and focusing on the outcome with evaluation of the patient's will. As part of the establishment of the innovation fund for HSR, promising intensive medical care projects have been promoted to improve the quality of care and the quality of long-term outcome for intensive care patients. An important focus lies on the identification of factors that improve long-term quality of life after intensive care. The expansion of registries and telemedicine in intensive care offers the opportunity to bundle and share experiences more effectively and thereby establish (guideline-based) treatment recommendations faster in the clinical practice.
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Affiliation(s)
- S Blecha
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - S Weber-Carstens
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Berlin, Deutschland
| | - T Bein
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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24
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Approaches to Addressing Post-Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review. Ann Am Thorac Soc 2020; 16:947-956. [PMID: 31162935 DOI: 10.1513/annalsats.201812-913fr] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.
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25
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Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Cost-Effectiveness of Parenteral Nutrition Containing ω-3 Fatty Acids in Hospitalized Adult Patients From 5 European Countries and the US. JPEN J Parenter Enteral Nutr 2020; 45:999-1008. [PMID: 32713007 PMCID: PMC8451886 DOI: 10.1002/jpen.1972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023]
Abstract
Background ω‐3 Fatty acid (FA)–containing parenteral nutrition (PN) is associated with improvements in patient outcomes and with reductions in hospital length of stay (HLOS) vs standard PN regimens (containing non–ω‐3 FA lipid emulsions). We present a cost‐effectiveness analysis of ω‐3 FA–containing PN vs standard PN in 5 European countries (France, Germany, Italy, Spain, UK) and the US. Methods This pharmacoeconomic model was based on estimates of ω‐3 efficacy reported in a recent meta‐analysis and data from country‐specific sources. It utilized a probabilistic discrete event simulation model to compare ω‐3 FA–containing PN with standard PN in a population of critically ill and general ward patients. The influence of model parameters was evaluated using probabilistic and deterministic sensitivity analyses. Results Overall costs were reduced with ω‐3 FA–containing PN in all 6 countries compared with standard PN, ranging from €1741 (±€1284) in Italy to €5576 (±€4193) in the US. Expenses for infections and HLOS were lower in all countries for ω‐3 FA–containing PN vs standard PN, with the largest cost differences for both in the US (infection: €825 ± €4001; HLOS: €4879 ± €1208) and the smallest savings in the UK for infections and in Spain for HLOS (€63 ± €426 and €1636 ± €372, respectively). Conclusion This cost‐effectiveness analysis in 6 countries demonstrates that the superior clinical efficacy of ω‐3 FA–containing PN translates into significant decreases in mean treatment cost, rendering it an attractive cost‐saving alternative to standard PN across different healthcare systems.
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Affiliation(s)
| | - Stanislaw Klek
- Department of General and Oncology Surgery with Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Konstantin Mayer
- ViDia Hospitals, Department of Pulmonary and Sleep Medicine, Karlsruhe, Germany
| | | | - Martin D Rosenthal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Axel R Heller
- Department of Anesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
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Oliveira RPD, Teixeira C, Rosa RG. Acute respiratory distress syndrome: how do patients fare after the intensive care unit? Rev Bras Ter Intensiva 2020; 31:555-560. [PMID: 31967232 PMCID: PMC7008991 DOI: 10.5935/0103-507x.20190074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
Patients with acute respiratory distress syndrome require ventilation strategies that have been shown to be important for reducing short-term mortality, such as protective ventilation and prone position ventilation. However, patients who survive have a prolonged stay in both the intensive care unit and the hospital, and they experience a reduction in overall satisfaction with life (independence, acceptance and positive outlook) as well as decreased mental health (including anxiety, depression and posttraumatic stress disorder symptoms), physical health (impaired physical state and activities of daily living; fatigue and muscle weakness), social health and the ability to participate in social activities (including relationships with friends and family, hobbies and social gatherings).
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Affiliation(s)
- Roselaine Pinheiro de Oliveira
- Unidade de Terapia Intensiva, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Régis Goulart Rosa
- Unidade de Terapia Intensiva, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
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27
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Apfelbacher C, Brandstetter S, Blecha S, Dodoo-Schittko F, Brandl M, Karagiannidis C, Quintel M, Kluge S, Putensen C, Bercker S, Ellger B, Kirschning T, Arndt C, Meybohm P, Weber-Carstens S, Bein T. Influence of quality of intensive care on quality of life/return to work in survivors of the acute respiratory distress syndrome: prospective observational patient cohort study (DACAPO). BMC Public Health 2020; 20:861. [PMID: 32503583 PMCID: PMC7275400 DOI: 10.1186/s12889-020-08943-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS. Methods To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDS patients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs). Results 877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34–52]) compared to the mental component (Md 47.3 IQR [33–57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = − 11.22, CI −20.71; − 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome. Conclusions Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out. Trial registration Clinicaltrials.govNCT02637011. (December 22, 2015, retrospectively registered)
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Affiliation(s)
- Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Susanne Brandstetter
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, 93051, Regensburg, Germany
| | - Sebastian Blecha
- Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, 93042, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, 93051, Regensburg, Germany
| | - Magdalena Brandl
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, 93051, Regensburg, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, 51109, Cologne, Germany
| | - Michael Quintel
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medicine, 37075, Göttingen, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre, Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Putensen
- Department of Anesthesiology and Operative Intensive Care, University Hospital Bonn, 53127, Bonn, Germany
| | - Sven Bercker
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Björn Ellger
- Department of Anesthesiology and Intensive Care, Klinikum Dortmund, 44137, Dortmund, Germany
| | - Thomas Kirschning
- Department of Anesthesiology and Intensive Care, University Hospital Mannheim, 68167, Mannheim, Germany
| | - Christian Arndt
- Department of Anesthesiology and Operative Intensive Care, University Hospital Marburg, 35042, Marburg, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Würzburg, 97080, Würzburg, Germany
| | - Steffen Weber-Carstens
- Department of Anaesthesiology and Intensive Care Medicine, Charité -University Medicine Berlin, 10117, Berlin, Germany
| | | | - Thomas Bein
- Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, 93042, Regensburg, Germany.
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Bartsch SM, Ferguson MC, McKinnell JA, O'Shea KJ, Wedlock PT, Siegmund SS, Lee BY. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States. Health Aff (Millwood) 2020; 39:927-935. [PMID: 32324428 PMCID: PMC11027994 DOI: 10.1377/hlthaff.2020.00426] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
With the coronavirus disease 2019 (COVID-19) pandemic, one of the major concerns is the direct medical cost and resource use burden imposed on the US health care system. We developed a Monte Carlo simulation model that represented the US population and what could happen to each person who got infected. We estimated resource use and direct medical costs per symptomatic infection and at the national level, with various "attack rates" (infection rates), to understand the potential economic benefits of reducing the burden of the disease. A single symptomatic COVID-19 case could incur a median direct medical cost of $3,045 during the course of the infection alone. If 80 percent of the US population were to get infected, the result could be a median of 44.6 million hospitalizations, 10.7 million intensive care unit (ICU) admissions, 6.5 million patients requiring a ventilator, 249.5 million hospital bed days, and $654.0 billion in direct medical costs over the course of the pandemic. If 20 percent of the US population were to get infected, there could be a median of 11.2 million hospitalizations, 2.7 million ICU admissions, 1.6 million patients requiring a ventilator, 62.3 million hospital bed days, and $163.4 billion in direct medical costs over the course of the pandemic.
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Affiliation(s)
- Sarah M Bartsch
- Sarah M. Bartsch is a project director at Public Health Informatics, Computational, and Operations Research (PHICOR), Graduate School of Public Health and Health Policy, City University of New York, in New York City
| | - Marie C Ferguson
- Marie C. Ferguson is a project director at PHICOR, Graduate School of Public Health and Health Policy, City University of New York
| | - James A McKinnell
- James A. McKinnell is an associate professor of medicine in the Infectious Disease Clinical Outcomes Research Unit, Lundquist Institute, Harbor-UCLA Medical Center, in Los Angeles, California
| | - Kelly J O'Shea
- Kelly J. O'Shea is a senior research analyst at PHICOR, Graduate School of Public Health and Health Policy, City University of New York
| | - Patrick T Wedlock
- Patrick T. Wedlock is a senior research analyst at PHICOR, Graduate School of Public Health and Health Policy, City University of New York
| | - Sheryl S Siegmund
- Sheryl S. Siegmund is director of operations at PHICOR, Graduate School of Public Health and Health Policy, City University of New York
| | - Bruce Y Lee
- Bruce Y. Lee is a professor of health policy and management at the Graduate School of Public Health and Health Policy and executive director of PHICOR, both at the City University of New York
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Oh TK, Song IA, Lee JH. Association of Economic Status and Mortality in Patients with Acute Respiratory Distress Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061815. [PMID: 32168795 PMCID: PMC7142506 DOI: 10.3390/ijerph17061815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
The high cost of treatment for acute respiratory distress syndrome (ARDS) is a concern for healthcare systems, while the impact of patients’ socio-economic status on the risk of ARDS-associated mortality remains controversial. This study investigated associations between patients’ income at the time of ARDS diagnosis and ARDS-specific mortality rate after treatment initiation. Data from records provided by the National Health Insurance Service of South Korea were used. Adult patients admitted for ARDS treatment from 2013 to 2017 were included in the study. Patients’ income in the year of diagnosis was evaluated. A total of 14,600 ARDS cases were included in the analysis. The 30-day and 1-year mortality rates were 48.6% and 70.3%, respectively. In multivariable Cox regression model, we compared income quartiles, showing that compared to income strata Q1, the Q2 (p = 0.719), Q3 (p = 0.946), and Q4 (p = 0.542) groups of income level did not affect the risk of 30-day mortality, respectively. Additionally, compared to income strata Q1, the Q2 (p = 0.762), Q3 (p = 0.420), and Q4 (p = 0.189) strata did not affect the risk of 1-year mortality. Patient income at the time of ARDS diagnosis did not affect the risk of 30-day or 1-year mortality in the present study based on South Korea’s health insurance data.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
- Correspondence:
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
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Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1304-1311. [DOI: 10.1513/annalsats.201903-248oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Kosilek RP, Baumeister SE, Ittermann T, Gründling M, Brunkhorst FM, Felix SB, Abel P, Friesecke S, Apfelbacher C, Brandl M, Schmidt K, Hoffmann W, Schmidt CO, Chenot JF, Völzke H, Gensichen JS. The association of intensive care with utilization and costs of outpatient healthcare services and quality of life. PLoS One 2019; 14:e0222671. [PMID: 31539397 PMCID: PMC6754134 DOI: 10.1371/journal.pone.0222671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background Little is known about outpatient health services use following critical illness and intensive care. We examined the association of intensive care with outpatient consultations and quality of life in a population-based sample. Methods Cross-sectional analysis of data from 6,686 participants of the Study of Health in Pomerania (SHIP), which consists of two independent population-based cohorts. Statistical modeling was done using Poisson regression, negative binomial and generalized linear models for consultations, and a fractional response model for quality of life (EQ-5D-3L index value), with results expressed as prevalence ratios (PR) or percent change (PC). Entropy balancing was used to adjust for observed confounding. Results ICU treatment in the previous year was reported by 139 of 6,686 (2,1%) participants, and was associated with a higher probability (PR 1.05 [CI:1.03;1.07]), number (PC +58.0% [CI:22.8;103.2]) and costs (PC +64.1% [CI:32.0;103.9]) of annual outpatient consultations, as well as with a higher number of medications (PC +37.8% [CI:17.7;61.5]). Participants with ICU treatment were more likely to visit a specialist (PR 1.13 [CI:1.09; 1.16]), specifically internal medicine (PR 1.67 [CI:1.45;1.92]), surgery (PR 2.42 [CI:1.92;3.05]), psychiatry (PR 2.25 [CI:1.30;3.90]), and orthopedics (PR 1.54 [CI:1.11;2.14]). There was no significant effect regarding general practitioner consultations. ICU treatment was also associated with lower health-related quality of life (EQ-5D index value: PC -13.7% [CI:-27.0;-0.3]). Furthermore, quality of life was inversely associated with outpatient consultations in the previous month, more so for participants with ICU treatment. Conclusions Our findings suggest that ICU treatment is associated with an increased utilization of outpatient specialist services, higher medication intake, and impaired quality of life.
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Affiliation(s)
- Robert P. Kosilek
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
- * E-mail:
| | - Sebastian E. Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Gründling
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Frank M. Brunkhorst
- Integrated Research and Treatment Center Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stephan B. Felix
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Peter Abel
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Sigrun Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine Greifswald, Greifswald, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Magdalena Brandl
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Carsten O. Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jean-François Chenot
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
- German Center for Diabetes Research, Site Greifswald, Greifswald, Germany
| | - Jochen S. Gensichen
- Institute of General Practice and Family Medicine, LMU München, Munich, Germany
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Patel B, Chatterjee S, Davignon S, Herlihy JP. Extracorporeal membrane oxygenation as rescue therapy for severe hypoxemic respiratory failure. J Thorac Dis 2019; 11:S1688-S1697. [PMID: 31632746 DOI: 10.21037/jtd.2019.05.73] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used for more than 50 years as salvage therapy for patients with severe cardiopulmonary failure refractory to conventional treatment. ECMO was first used in the 1960s to treat hypoxemic respiratory failure in newborns. On the basis of its success in that population, ECMO began to be used in the early 1970s to treat adult hypoxemic respiratory failure. However, outcomes for adults were, somewhat perplexingly, quite poor. By the 1980s, use of ECMO for severe hypoxemia was rare outside of the pediatric population. ECMO technology, however, continued to evolve and improve. Multiple case reports and small series describing ECMO use as rescue for adults with severe hypoxemia from various lung pathologies have appeared in the literature over the past three decades. Adult respiratory distress syndrome (ARDS) is often the final common pathway of various pathologies affecting adults and causing hypoxemic respiratory failure. It is prevalent in intensive care units throughout the world and has, since it was first described in 1967, carried a high mortality. No specific therapy for ARDS has been found, and current care is supportive, primarily by mechanical ventilation. Results from recent randomized controlled trials, however, suggest that ECMO may have a place in the treatment of these patients. This article reviews these studies and recommends adding severe ARDS to the list of established indications for ECMO in patients with hypoxemic respiratory failure.
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Affiliation(s)
- Bhoumesh Patel
- Division of Cardiovascular Anesthesiology and Critical Care, Baylor College of Medicine/Texas Heart Institute, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | | | - Seanna Davignon
- Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine/Texas Heart Institute, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - J Patrick Herlihy
- Division of Pulmonary and Critical Care Medicine, Baylor College of Medicine/Texas Heart Institute, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
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Saunders R, Lankiewicz J. The Cost Effectiveness of Single-Patient-Use Electrocardiograph Cable and Lead Systems in Monitoring for Coronary Artery Bypass Graft Surgery. Front Cardiovasc Med 2019; 6:61. [PMID: 31134212 PMCID: PMC6523521 DOI: 10.3389/fcvm.2019.00061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background: During admission for coronary artery bypass graft (CABG) surgery patients receive electrocardiograph (ECG) monitoring; for which reusable ECG cable and leads (rECG) are standard. Objective: Evaluate the cost effectiveness of a single-patient-use ECG cable and lead system (spECG). Methods: Review of the Medicare 2011-2014 database followed by a cost-effectiveness model considering a Medicare facility transitioning from rECG ($9 per patient) to spECG ($15). In-hospital ECG monitoring was for ≤8 days. In the model, patients underwent CABG and recovered in the intensive care unit, before transfer to the general ward and discharge. Surgical site infection (SSI) resulted in increased length of stay, readmission, or outpatient care. Health outcomes impacted EQ-5D-measured quality adjusted life years (QALYs). Health and cost outcomes were discounted at 3.5% annually. All costs in 2016 USD. Significance (95% level) was assessed via 2,000 simulations. Results: In 2014, 5.49% of patients had an SSI by 90-days post-surgery, with spECG reducing the odds of an SSI (odds ratio: 0.74, 0.62-0.89). Mean 40-year, per-patient costs to Medicare were $65,497 with rECG and $65,048 with spECG. The $450 saving was significant, with a median (95% credible interval) reduction of $466 ($174 to $989). Cost drivers were days required to treat inpatient SSIs. QALYs increases with spECG were significant but minor (median increase 0.008). Medicare savings may total $40 million per year with use of spECG. Conclusions: Post-operative SSI is a concern for Medicare patients undergoing CABG, and use of spECG is likely to provide cost and patient benefits.
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Shaw TD, McAuley DF, O’Kane CM. Emerging drugs for treating the acute respiratory distress syndrome. Expert Opin Emerg Drugs 2019; 24:29-41. [DOI: 10.1080/14728214.2019.1591369] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Timothy D. Shaw
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
| | - Daniel F. McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK
| | - Cecilia M. O’Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, UK
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Long-term outcome after the acute respiratory distress syndrome: different from general critical illness? Curr Opin Crit Care 2018; 24:35-40. [PMID: 29189296 PMCID: PMC5757654 DOI: 10.1097/mcc.0000000000000476] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of review To review the current research data on long-term outcome and health-related quality of life in survivors of the acute respiratory distress syndrome (ARDS) and to compare these findings with those from non-ARDS patients surviving critical illness. Recent findings Between 6 months and 2 years after discharge from ICU, survivors of ARDS present with substantial impairments of the levels of body function (muscle strength, walking capacity and/or physical activity (physical SF-36 score). In contrast to non-ARDS patients from surgical ICUs, a standardized intensified physical therapy during early course of illness in ARDS patients could not show an improvement of long-term physical function performance. Furthermore, a substantial part of further ARDS patients suffer from depression (26–33%), anxiety (38–44%) or posttraumatic stress disorder (22–24%). In general, the level of functional autonomy and daily life activities was reduced, and in one study, 6 months after ICU-discharge this level was significantly lower in ARDS patients compared with non-ARDS patients. In a recent study, 44% of ARDS survivors were jobless 1 year after critical illness, whereas half of previously employed patients returned to work within 4 months after hospital discharge. General health-related quality of life was significantly reduced compared with a matched population in all studies. Summary Surviving ARDS is associated with a long-term substantial reduction in health-related quality of life and such a reduction does not differ from findings in patients surviving other critical illness. In further research, a special attention should be paid to prevention measures of the ‘post intensive care syndrome’ as well as to patient important domains, which might better explain the patient's and families’ demands.
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Saunders R, Geogopoulos D. Evaluating the Cost-Effectiveness of Proportional-Assist Ventilation Plus vs. Pressure Support Ventilation in the Intensive Care Unit in Two Countries. Front Public Health 2018; 6:168. [PMID: 29928641 PMCID: PMC5998768 DOI: 10.3389/fpubh.2018.00168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Here, the cost effectiveness of proportional assist ventilation (PAV™ ventilation by Medtronic) is estimated relative to pressure support ventilation (PSV). Methods: A cohort-level, clinical model was built using data from clinical trials. The model estimates patient-ventilator asynchrony >10%, tracheostomy, ventilator-associated pneumonia, other nosocomial infections, spontaneous breathing trial success, hypoxemia, and death. Cost and quality of life are associated with all events, with cost effectiveness defined as the cost per quality-adjusted life year (QALY) gained in the US and UK. Results: The mean cost of ICU care was lower with PAV™ than with PSV in the US and UK, but the total cost of care over 40 years was higher due to more patients surviving and incurring future care costs. Reduced time on mechanical ventilation, fewer nosocomial infections, and extended life expectancy with PAV™ drove QALY improvement. The cost per QALY gained with PAV™ was $8,628 and £2,985. Conclusion: PAV™ improves quality of life and reduces short-term costs. PAV™ is likely to be considered cost-effective over 40-years in the US and UK.
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Affiliation(s)
| | - Dimitris Geogopoulos
- Medical School, University Hospital of Heraklion, University of Crete, Heraklion, Greece
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Lindemark F, Haaland ØA, Kvåle R, Flaatten H, Norheim OF, Johansson KA. Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis. Crit Care 2017; 21:220. [PMID: 28830479 PMCID: PMC5567919 DOI: 10.1186/s13054-017-1792-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 07/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. METHODS We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. RESULTS The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more cost-effective. CONCLUSIONS On average, ICU admission versus general ward care was cost-effective at a threshold of €22,000/QALY (p = 95%). According to the individualized cost-effectiveness information, one in six ICU admissions was not cost-effective at a threshold of €64,000/QALY. Almost half of these admissions that were not cost-effective can be regarded as acceptable when weighted by severity of disease in terms of expected lifetime health. Overall, existing ICU services represent reasonable resource use, but considerable uncertainty becomes evident when disaggregating into individualized results.
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Affiliation(s)
- Frode Lindemark
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein A. Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Reidar Kvåle
- Norwegian Intensive Care Registry, Helse Bergen HF, Bergen, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hans Flaatten
- Norwegian Intensive Care Registry, Helse Bergen HF, Bergen, Norway
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ole F. Norheim
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell A. Johansson
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study. Intensive Care Med 2017; 43:980-991. [DOI: 10.1007/s00134-017-4827-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
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