Cost-utility in medical intensive care patients rationalizing ongoing care and timing of discharge from intensive care

Kurien Thomas, John Victor Peter, Jony Christina, Anna Revathi Jagadish, Amala Rajan, Prabha Lionel, Lakshmanan Jeyaseelan, Bijesh Yadav, George John, Kishore Pichamuthu, Binila Chacko, Priscilla Pari, Thilagavathi Murugesan, Kavitha Rajendran, Anu John, Sowmya Sathyendra, Ramya Iyyadurai, Sudha Jasmine, Rajiv Karthik, Alice Mathuram & 5 others Samuel George Hansdak, Kundavaram Paul P Abhilash, Shuba Kumar, K. R. John, Thambu David Sudarsanam

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Rationale: Intensive care unit (ICU) treatment costs pose special challenges in developing countries. Objectives: To determine the prognostic value of the "utility" score and evaluate the relationship of willingness to pay assessment to utility score during ICU admission. Methods: We performed a prospective study spanning 12 months in a 24-bed medical ICU in India. Treatment cost was estimated by direct measurement. Global utility score was assessed daily by healthcare providers on a Likert scale (0-1 in increments of 0.1, with 0 indicating death/severe disability and 1 indicating cure/perfect health). The sensitivity, specificity, and likelihood ratios of utility in predicting ICU mortality was calculated. Receiver operating characteristic curves were generated to compare Day 2 utility withAPACHEII. The caregiver's willingness to pay for treatment was assessed on alternate days using the bidding method by presenting a cost bid. Based on the response ("yes" or "no"), bids were increased or decreased in a prespecified manner until a final bid value was reached. Simultaneously, treating doctors were asked how much institutional funds they would be willing to spend for treatment. Measurements and Main Results: Primary diagnosis in 499 patients included infection (26%) and poisoning (21%). The mean (SD) APACHE II score was 13.9 (5.8); 86% were ventilated. ICU stay was 7.8 (5.5) days. ICU mortality was 23.9% (95% confidence interval, 20.3-27.8). Survivalwithout disabilitywas 8.3%(2/24) forDay 2 utility score ≤0.3 and 95.8% (53/56) for Day 5 score >0.8 (P<0.001). The likelihood ratio to predict mortality increased as utility values decreased and was highest (5.85) for utility 0.2. Area under the receiver operating characteristic curves for utility and APACHE II were similar. Willingness to pay by the caregiverwas 53%of treatment cost and was not influenced by utility. Willingness to pay by ICU doctors showed an inverted U-shaped relationship with utility. Conclusions: Utility scores help prognosticate, with Day 2 score ≤0.3 associated with poor outcome and ≥0.8 Day 5 score with survival. The caregiver's willingness to pay was inadequate to meet treatment cost. ICU doctors were willing to spend more for moderate utility scores than for very high or low utility values. Further prospective studies are needed to optimize the utilization of scarce ICU resources by identifying patients for appropriate step-down care using utility and willingness to pay.

Original languageEnglish
Pages (from-to)1058-1065
Number of pages8
JournalAnnals of the American Thoracic Society
Volume12
Issue number7
DOIs
Publication statusPublished - Jul 1 2015

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Critical Care
Intensive Care Units
Costs and Cost Analysis
Health Care Costs
APACHE
ROC Curve
Caregivers
Mortality
Prospective Studies
Financial Management
Health Personnel
Poisoning
Developing Countries
India
Confidence Intervals
Sensitivity and Specificity
Survival
Health
Therapeutics
Infection

Keywords

  • Cost-utility
  • Health economics
  • Intensive care
  • Willingness-to-pay

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Cost-utility in medical intensive care patients rationalizing ongoing care and timing of discharge from intensive care. / Thomas, Kurien; Peter, John Victor; Christina, Jony; Jagadish, Anna Revathi; Rajan, Amala; Lionel, Prabha; Jeyaseelan, Lakshmanan; Yadav, Bijesh; John, George; Pichamuthu, Kishore; Chacko, Binila; Pari, Priscilla; Murugesan, Thilagavathi; Rajendran, Kavitha; John, Anu; Sathyendra, Sowmya; Iyyadurai, Ramya; Jasmine, Sudha; Karthik, Rajiv; Mathuram, Alice; Hansdak, Samuel George; Abhilash, Kundavaram Paul P; Kumar, Shuba; John, K. R.; Sudarsanam, Thambu David.

In: Annals of the American Thoracic Society, Vol. 12, No. 7, 01.07.2015, p. 1058-1065.

Research output: Contribution to journalArticle

Thomas, K, Peter, JV, Christina, J, Jagadish, AR, Rajan, A, Lionel, P, Jeyaseelan, L, Yadav, B, John, G, Pichamuthu, K, Chacko, B, Pari, P, Murugesan, T, Rajendran, K, John, A, Sathyendra, S, Iyyadurai, R, Jasmine, S, Karthik, R, Mathuram, A, Hansdak, SG, Abhilash, KPP, Kumar, S, John, KR & Sudarsanam, TD 2015, 'Cost-utility in medical intensive care patients rationalizing ongoing care and timing of discharge from intensive care', Annals of the American Thoracic Society, vol. 12, no. 7, pp. 1058-1065. https://doi.org/10.1513/AnnalsATS.201411-527OC
Thomas, Kurien ; Peter, John Victor ; Christina, Jony ; Jagadish, Anna Revathi ; Rajan, Amala ; Lionel, Prabha ; Jeyaseelan, Lakshmanan ; Yadav, Bijesh ; John, George ; Pichamuthu, Kishore ; Chacko, Binila ; Pari, Priscilla ; Murugesan, Thilagavathi ; Rajendran, Kavitha ; John, Anu ; Sathyendra, Sowmya ; Iyyadurai, Ramya ; Jasmine, Sudha ; Karthik, Rajiv ; Mathuram, Alice ; Hansdak, Samuel George ; Abhilash, Kundavaram Paul P ; Kumar, Shuba ; John, K. R. ; Sudarsanam, Thambu David. / Cost-utility in medical intensive care patients rationalizing ongoing care and timing of discharge from intensive care. In: Annals of the American Thoracic Society. 2015 ; Vol. 12, No. 7. pp. 1058-1065.
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author = "Kurien Thomas and Peter, {John Victor} and Jony Christina and Jagadish, {Anna Revathi} and Amala Rajan and Prabha Lionel and Lakshmanan Jeyaseelan and Bijesh Yadav and George John and Kishore Pichamuthu and Binila Chacko and Priscilla Pari and Thilagavathi Murugesan and Kavitha Rajendran and Anu John and Sowmya Sathyendra and Ramya Iyyadurai and Sudha Jasmine and Rajiv Karthik and Alice Mathuram and Hansdak, {Samuel George} and Abhilash, {Kundavaram Paul P} and Shuba Kumar and John, {K. R.} and Sudarsanam, {Thambu David}",
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T1 - Cost-utility in medical intensive care patients rationalizing ongoing care and timing of discharge from intensive care

AU - Thomas, Kurien

AU - Peter, John Victor

AU - Christina, Jony

AU - Jagadish, Anna Revathi

AU - Rajan, Amala

AU - Lionel, Prabha

AU - Jeyaseelan, Lakshmanan

AU - Yadav, Bijesh

AU - John, George

AU - Pichamuthu, Kishore

AU - Chacko, Binila

AU - Pari, Priscilla

AU - Murugesan, Thilagavathi

AU - Rajendran, Kavitha

AU - John, Anu

AU - Sathyendra, Sowmya

AU - Iyyadurai, Ramya

AU - Jasmine, Sudha

AU - Karthik, Rajiv

AU - Mathuram, Alice

AU - Hansdak, Samuel George

AU - Abhilash, Kundavaram Paul P

AU - Kumar, Shuba

AU - John, K. R.

AU - Sudarsanam, Thambu David

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Rationale: Intensive care unit (ICU) treatment costs pose special challenges in developing countries. Objectives: To determine the prognostic value of the "utility" score and evaluate the relationship of willingness to pay assessment to utility score during ICU admission. Methods: We performed a prospective study spanning 12 months in a 24-bed medical ICU in India. Treatment cost was estimated by direct measurement. Global utility score was assessed daily by healthcare providers on a Likert scale (0-1 in increments of 0.1, with 0 indicating death/severe disability and 1 indicating cure/perfect health). The sensitivity, specificity, and likelihood ratios of utility in predicting ICU mortality was calculated. Receiver operating characteristic curves were generated to compare Day 2 utility withAPACHEII. The caregiver's willingness to pay for treatment was assessed on alternate days using the bidding method by presenting a cost bid. Based on the response ("yes" or "no"), bids were increased or decreased in a prespecified manner until a final bid value was reached. Simultaneously, treating doctors were asked how much institutional funds they would be willing to spend for treatment. Measurements and Main Results: Primary diagnosis in 499 patients included infection (26%) and poisoning (21%). The mean (SD) APACHE II score was 13.9 (5.8); 86% were ventilated. ICU stay was 7.8 (5.5) days. ICU mortality was 23.9% (95% confidence interval, 20.3-27.8). Survivalwithout disabilitywas 8.3%(2/24) forDay 2 utility score ≤0.3 and 95.8% (53/56) for Day 5 score >0.8 (P<0.001). The likelihood ratio to predict mortality increased as utility values decreased and was highest (5.85) for utility 0.2. Area under the receiver operating characteristic curves for utility and APACHE II were similar. Willingness to pay by the caregiverwas 53%of treatment cost and was not influenced by utility. Willingness to pay by ICU doctors showed an inverted U-shaped relationship with utility. Conclusions: Utility scores help prognosticate, with Day 2 score ≤0.3 associated with poor outcome and ≥0.8 Day 5 score with survival. The caregiver's willingness to pay was inadequate to meet treatment cost. ICU doctors were willing to spend more for moderate utility scores than for very high or low utility values. Further prospective studies are needed to optimize the utilization of scarce ICU resources by identifying patients for appropriate step-down care using utility and willingness to pay.

AB - Rationale: Intensive care unit (ICU) treatment costs pose special challenges in developing countries. Objectives: To determine the prognostic value of the "utility" score and evaluate the relationship of willingness to pay assessment to utility score during ICU admission. Methods: We performed a prospective study spanning 12 months in a 24-bed medical ICU in India. Treatment cost was estimated by direct measurement. Global utility score was assessed daily by healthcare providers on a Likert scale (0-1 in increments of 0.1, with 0 indicating death/severe disability and 1 indicating cure/perfect health). The sensitivity, specificity, and likelihood ratios of utility in predicting ICU mortality was calculated. Receiver operating characteristic curves were generated to compare Day 2 utility withAPACHEII. The caregiver's willingness to pay for treatment was assessed on alternate days using the bidding method by presenting a cost bid. Based on the response ("yes" or "no"), bids were increased or decreased in a prespecified manner until a final bid value was reached. Simultaneously, treating doctors were asked how much institutional funds they would be willing to spend for treatment. Measurements and Main Results: Primary diagnosis in 499 patients included infection (26%) and poisoning (21%). The mean (SD) APACHE II score was 13.9 (5.8); 86% were ventilated. ICU stay was 7.8 (5.5) days. ICU mortality was 23.9% (95% confidence interval, 20.3-27.8). Survivalwithout disabilitywas 8.3%(2/24) forDay 2 utility score ≤0.3 and 95.8% (53/56) for Day 5 score >0.8 (P<0.001). The likelihood ratio to predict mortality increased as utility values decreased and was highest (5.85) for utility 0.2. Area under the receiver operating characteristic curves for utility and APACHE II were similar. Willingness to pay by the caregiverwas 53%of treatment cost and was not influenced by utility. Willingness to pay by ICU doctors showed an inverted U-shaped relationship with utility. Conclusions: Utility scores help prognosticate, with Day 2 score ≤0.3 associated with poor outcome and ≥0.8 Day 5 score with survival. The caregiver's willingness to pay was inadequate to meet treatment cost. ICU doctors were willing to spend more for moderate utility scores than for very high or low utility values. Further prospective studies are needed to optimize the utilization of scarce ICU resources by identifying patients for appropriate step-down care using utility and willingness to pay.

KW - Cost-utility

KW - Health economics

KW - Intensive care

KW - Willingness-to-pay

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