Data from: Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system

Objectives: There is a scarcity of literature reporting hospital costs for treating out of hospital cardiac arrest (OOHCA) survivors, especially within the UK. This is essential for assessment of cost-effectiveness of interventions necessary to allow just allocation of resources within the National Health Service. We set out primarily to calculate costs stratified against hospital survival and neurological outcomes. Secondarily, we estimated cost effectiveness based on estimates of survival and utility from previous studies to calculate costs per quality adjusted life year (QALY). Setting: We performed a single centre (London) retrospective review of in-hospital costs of patients admitted to the intensive care unit (ICU) following return of spontaneous circulation (ROSC) after OOHCA over 18 months from January 2011 (following widespread introduction of targeted temperature management and primary percutaneous intervention). Participants: Of 69 successive patients admitted over an 18-month period, survival and cerebral performance category (CPC) outcomes were obtained from review of databases and clinical notes. The Trust finance department supplied ICU and hospital costs using the Payment by Results UK system. Results: Of those patients with ROSC admitted to ICU, survival to hospital discharge (any CPC) was 33/69 (48%) with 26/33 survivors in CPC 1–2 at hospital discharge. Cost per survivor to hospital discharge (including total cost of survivors and non-survivors) was £50 000, cost per CPC 1–2 survivor was £65 000. Cost and length of stay of CPC 1–2 patients was considerably lower than CPC 3–4 patients. The majority of the costs (69%) related to intensive care. Estimated cost per CPC 1–2 survivor per QALY was £16 000. Conclusions: The costs of in-hospital patient care for ICU admissions following ROSC after OOHCA are considerable but within a reasonable threshold when assessed from a QALY perspective.研究目标：目前鲜有文献报道院外心脏骤停（out of hospital cardiac arrest, OOHCA）幸存者的住院治疗成本，在英国境内尤为如此。该类成本数据对于评估干预措施的成本效益至关重要，可助力英国国民保健制度（National Health Service）实现资源的合理分配。本研究首要目标为按患者住院存活情况及神经功能结局分层计算治疗成本；次要目标为基于既往研究中的存活数据与效用值估算成本效益，进而计算每质量调整生命年（quality adjusted life year, QALY）的治疗成本。 研究场景：本研究为单中心（伦敦）回顾性研究，分析了2011年1月起为期18个月内，院外心脏骤停后恢复自主循环（return of spontaneous circulation, ROSC）并收入重症监护病房（intensive care unit, ICU）的患者的住院成本。本次研究时段覆盖目标温度管理与首次经皮介入干预全面推广之后的周期。 研究对象：本研究纳入18个月内连续收治的69例患者，通过查阅数据库与临床病历获取其存活情况及脑功能分级（cerebral performance category, CPC）结局。本院信托财务部门通过英国按结果付费体系提供了重症监护病房及住院治疗的相关成本数据。 研究结果：在收入重症监护病房的恢复自主循环患者中，33例（48%）存活至出院（任意脑功能分级），其中26例出院时脑功能分级为1~2级。按所有存活者与非存活者总成本计算，每例住院存活者的治疗成本为50000英镑；每例脑功能分级1~2级存活者的治疗成本为65000英镑。脑功能分级1~2级患者的治疗成本与住院时长均显著低于脑功能分级3~4级患者。69%的治疗成本集中于重症监护阶段。每例脑功能分级1~2级存活者的每质量调整生命年花费估算为16000英镑。 研究结论：院外心脏骤停恢复自主循环后收入重症监护病房的患者，其住院治疗成本不菲，但从质量调整生命年视角评估时，该成本处于合理阈值范围内。