Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest

Jürgen Graf¹ , Cecile Mühlhoff² , Gordon S Doig³ , Sebastian Reinartz⁴ , Kirsten Bode⁴ , Robert Dujardin⁵ , Karl-Christian Koch⁶ , Elke Roeb⁷ and Uwe Janssens⁴

¹Department of Anaesthesia and Intensive Care Medicine and Department of Cardiovascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043 Marburg, Germany

²Department of Dermatology, RWTH Aachen, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

³Department of Intensive Care, Royal North Shore Hospital and Senior Lecturer in Intensive Care, Northern Clinical School, Department of Medicine, University of Sydney, NSW 2006 Sydney, Australia

⁴Medical Clinic, St. Antonius Hospital Eschweiler, Dechant-Decker-Strasse, 52249 Eschweiler, Germany

⁵Zentrale Patientenaufnahme, Malteser-Krankenhaus St. Elisabeth, Kurfürstenstrasse 22, 52428 Jülich, Germany

⁶Medical Clinic I, Department of Cardiology and Intensive Care Medicine, RWTH Aachen, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany

⁷Department of Medicine II, Head of Gastroenterology, Justus-Liebig-University Giessen, Paul-Meimberg-Strasse 5, 35385 Giessen, Germany

author email corresponding author email

Critical Care 2008, 12:R92doi:10.1186/cc6963


Published:	18 July 2008

See related commentary by Warren and Nichol, http://ccforum.com/content/12/4/173

Abstract

Introduction

The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation.

Methods

Five-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs, hospital costs and post-hospital health care costs per survivor, costs per life year gained, and costs per quality-adjusted life year gained of patients admitted to a single ICU were assessed.

Results

One hundred ten of 354 patients (31%) were alive 5 years after hospital discharge. The mean health status index of 5-year survivors was 0.77 (95% confidence interval 0.70 to 0.85). Women rated their health-related quality of life significantly better than men did (0.87 versus 0.74; P < 0.05). Costs per hospital discharge survivor were 49,952 €. Including the costs of post-hospital discharge health care incurred during their remaining life span, the total costs per life year gained were 10,107 €. Considering 5-year survivors only, the costs per life year gained were calculated as 9,816 € or 14,487 € per quality-adjusted life year gained. Including seven patients with severe neurological sequelae, costs per life year gained in 5-year survivors increased by 18% to 11,566 €.

Conclusion

Patients who leave the hospital following cardiac arrest without severe neurological disabilities may expect a reasonable quality of life compared with age- and gender-matched controls. Quality-adjusted costs for this patient group appear to be within ranges considered reasonable for other groups of patients.