Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure
R. M. Wachter, J. M. Luce, S. Safrin, D. C. Berrios, E. Charlebois and A. A. Scitovsky
Medical Service, San Francisco General Hospital Medical Center.
OBJECTIVE--To determine the costs and outcomes associated with intensive
care unit (ICU) admission for patients with acquired immunodeficiency
syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), and severe
respiratory failure. DESIGN--Survival and cost-effectiveness analysis.
SETTING--A large municipal teaching hospital serving an indigent
population. PATIENTS--Consecutive patients intubated and mechanically
ventilated for AIDS, PCP, and respiratory failure from 1981 through 1991 (n
= 113). The cohort was separated into three groups for analysis: patients
admitted to the ICU in 1981 through 1985 (era I, n = 43), those admitted in
1986 through 1988 (era II, n = 33), and those admitted in 1989 through 1991
(era III, n = 37). MAIN OUTCOME MEASURES--Hospital charges and survival
time; cost per year of life saved, using a zero-cost, zero-life assumption.
RESULTS--Twenty-eight (25%) of the 113 patients mechanically ventilated for
PCP and respiratory failure survived to hospital discharge: six (14%) of 43
in era I, 13 (39%) of 33 in era II, and nine (24%) of 37 in era III (P =
.04). Post-ICU admission charges averaged $57,874 for the entire cohort,
remaining relatively stable across the three eras. Cost of care for
survivors was significantly more expensive than for those dying before
discharge. The cost of ICU admission and subsequent hospitalization
averaged $174,781 per year of life saved; $305,795 in era I, $94,528 in era
II, and $215,233 in era III. Improved survival rates and shorter lengths of
ICU stay led to the improved cost-effectiveness in era II, while the
opposite trends resulted in worsening cost-effectiveness in recent years.
The strongest predictors of hospital mortality in era III were low CD4 cell
counts on hospital admission and the development of pneumothorax during
mechanical ventilation. CONCLUSIONS--The cost-effectiveness of intensive
care for patients with PCP and severe respiratory failure improved during
the first 8 years of the AIDS epidemic but fell in recent years such that
it is now below that of many accepted medical interventions.
Improved survival for HIV infected patients with severe Pneumocystis jirovecii pneumonia is independent of highly active antiretroviral therapy
Miller et al.
Thorax 2006;61:716-721.
ABSTRACT
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Outcome of Critically Ill Human Immunodeficiency Virus-Infected Patients in the Era of Highly Active Antiretroviral Therapy
Khouli et al.
J Intensive Care Med 2005;20:279-285.
ABSTRACT
Acute Respiratory Failure Due to Pneumocystis Pneumonia in Patients Without Human Immunodeficiency Virus Infection: Outcome and Associated Features
Festic et al.
Chest 2005;128:573-579.
ABSTRACT
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Intensive Care of Human Immunodeficiency Virus-infected Patients during the Era of Highly Active Antiretroviral Therapy
Morris et al.
Am. J. Respir. Crit. Care Med. 2002;166:262-267.
ABSTRACT
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Can Health Care Costs Be Reduced by Limiting Intensive Care at the End of Life?
LUCE and RUBENFELD
Am. J. Respir. Crit. Care Med. 2002;165:750-754.
FULL TEXT
Cost and Outcome of Mechanical Ventilation for Life-Threatening Stroke
Mayer et al.
Stroke 2000;31:2346-2353.
ABSTRACT
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Improvements in Outcomes of Acute Respiratory Failure for Patients with Human Immunodeficiency Virus-related Pneumocystis carinii Pneumonia
RANDALL CURTIS et al.
Am. J. Respir. Crit. Care Med. 2000;162:393-398.
ABSTRACT
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Clinical Course, Prognostic Factors, and Outcome Prediction for HIV Patients in the ICU : The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study
Afessa and Green
Chest 2000;118:138-145.
ABSTRACT
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Outcomes of Intensive Care for Patients With Human Immunodeficiency Virus Infection
Nickas and Wachter
Arch Intern Med 2000;160:541-547.
ABSTRACT
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Determinants of Short- and Long-term Outcome in Patients With Respiratory Failure Caused by AIDS-Related Pneumocystis carinii Pneumonia
Forrest et al.
Arch Intern Med 1999;159:741-747.
ABSTRACT
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