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01-12-2015 | Commentary

Is critical care ready for an economic surrogate endpoint?

Authors: M Elizabeth Wilcox, Gordon D Rubenfeld

Published in: Critical Care | Issue 1/2015

Abstract

Intensive care is expensive, and thus a body of research has focused on strategies to reduce its costs. However, efforts to reduce the total cost of intensive care have met with limited success, partly because of the challenges of calculating how much a day in the ICU actually costs. We discuss these challenges and introduce the concept of total cost savings as an outcome of critical care trials, assuming statistically negative effects on mortality and quality of life.

Halpern NA. Can the costs of critical care be controlled? Curr Opin Crit Care. 2009;15:591–6.CrossRefPubMedCentral

Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA. 1999;282:554–60.CrossRefPubMedCentral

Brill S. Bitter pill: why medical bills are killing us. In: Time. Tampa: Time Inc.; 2013.

Kollef MH, Hamilton CW, Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012;33:250–6.CrossRefPubMedCentral

Mercier G, Naro G. Costing hospital surgery services: the method matters. PLoS One. 2014;9, e97290.CrossRefPubMedCentral

Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, et al. Distribution of variable vs fixed costs of hospital care. JAMA. 1999;281:644–9.CrossRefPubMedCentral

Reinhardt UE. Spending more through ‘cost control:’ our obsessive quest to gut the hospital. Health Affairs. 1996;15:145–54.CrossRefPubMedCentral

Taheri PA, Butz DA, Greenfield LJ. Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg. 2000;191:123–30.CrossRefPubMedCentral

Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33:1266–71.CrossRefPubMedCentral

10.

Kahn JM, Rubenfeld GD, Rohrbach J, Fuchs BD. Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Med Care. 2008;46:1226–33.CrossRefPubMedCentral

11.

Turunen H, Jakob SM, Ruokonen E, Kaukonen KM, Sarapohja T, Apajasalo M, et al. Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation. Crit Care. 2015;19:67.CrossRefPubMedCentral

12.

Kassirer JP, Angell M. The journal's policy on cost-effectiveness analyses. N Engl J Med. 1994;331:669–70.CrossRefPubMedCentral

13.

Rubenfeld GD. Who cares about preventing acute respiratory distress syndrome? Am J Respir Crit Care Med. 2015;191:255–60.CrossRefPubMedCentral

14.

Blackwood B, Clarke M, McAuley DF, McGuigan PJ, Marshall JC, Rose L. How outcomes are defined in clinical trials of mechanically ventilated adults and children. Am J Respir Crit Care Med. 2014;189:886–93.CrossRefPubMedCentral

15.

Briggs AH, O'Brien BJ. The death of cost-minimization analysis? Health Econ. 2001;10:179–84.CrossRefPubMedCentral

16.

Dakin H, Wordsworth S. Cost-minimisation analysis versus cost-effectiveness analysis, revisited. Health Econ. 2013;22:22–34.CrossRefPubMedCentral

Title: Is critical care ready for an economic surrogate endpoint?
Authors: M Elizabeth Wilcox
Gordon D Rubenfeld
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-015-0947-0

At a glance: The STEP trials

Springer Medicine

Is critical care ready for an economic surrogate endpoint?

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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