Linemark F et al. – This modeling study described the additional costs and anticipated health gains accompanying intensive care unit (ICU) admission versus general ward care for 30,712 patients and the variation in cost–effectiveness estimates among subgroups and individuals. A distribution–weighted economic evaluation was performed by incorporating more weightage to high disease severity. Overall, existing ICU services represent reasonable resource use; however, considerable uncertainty becomes evident when disaggregating into individualized results.

Methods

• A decision–analytic model estimated the incremental cost per quality–adjusted life year (QALY) gained/incremental cost–effectiveness ratio (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. Increasing weights were assigned to health gains for patients with higher severity of disease, defined as less expected lifetime health if not admitted. The study had inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty was explored in probabilistic sensitivity analysis.

Results

• ICU admission versus general ward care was cost–effective at a threshold of €22,000/QALY (P = 95%); however, 1 in 6 ICU admissions was not cost–effective at a threshold of €64,000/QALY and nearly half of these admissions were considered acceptable in terms of expected lifetime health when weighted by disease severity.
• In the distributional evaluation, 8% of all patients had distribution–weighted ICERs above €64,000/QALY.
• High–severity admissions proved to be more cost–effective.