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Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study
BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694900/ https://www.ncbi.nlm.nih.gov/pubmed/38049894 http://dx.doi.org/10.1186/s40560-023-00708-w |
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author | Ikumi, Saori Shiga, Takuya Ueda, Takuya Takaya, Eichi Iwasaki, Yudai Kaiho, Yu Tarasawa, Kunio Fushimi, Kiyohide Ito, Yukiko Fujimori, Kenji Yamauchi, Masanori |
author_facet | Ikumi, Saori Shiga, Takuya Ueda, Takuya Takaya, Eichi Iwasaki, Yudai Kaiho, Yu Tarasawa, Kunio Fushimi, Kiyohide Ito, Yukiko Fujimori, Kenji Yamauchi, Masanori |
author_sort | Ikumi, Saori |
collection | PubMed |
description | BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4. METHODS: This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective. RESULTS: The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold. CONCLUSIONS: ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40560-023-00708-w. |
format | Online Article Text |
id | pubmed-10694900 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-106949002023-12-05 Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study Ikumi, Saori Shiga, Takuya Ueda, Takuya Takaya, Eichi Iwasaki, Yudai Kaiho, Yu Tarasawa, Kunio Fushimi, Kiyohide Ito, Yukiko Fujimori, Kenji Yamauchi, Masanori J Intensive Care Research BACKGROUND: Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4. METHODS: This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective. RESULTS: The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold. CONCLUSIONS: ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40560-023-00708-w. BioMed Central 2023-12-04 /pmc/articles/PMC10694900/ /pubmed/38049894 http://dx.doi.org/10.1186/s40560-023-00708-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Ikumi, Saori Shiga, Takuya Ueda, Takuya Takaya, Eichi Iwasaki, Yudai Kaiho, Yu Tarasawa, Kunio Fushimi, Kiyohide Ito, Yukiko Fujimori, Kenji Yamauchi, Masanori Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title | Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title_full | Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title_fullStr | Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title_full_unstemmed | Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title_short | Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study |
title_sort | intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a japanese nationwide observational study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694900/ https://www.ncbi.nlm.nih.gov/pubmed/38049894 http://dx.doi.org/10.1186/s40560-023-00708-w |
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