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Related Experiment Videos

Intensive care unit prognostic scoring systems to predict death: a cost-effectiveness analysis

L G Glance1, T Osler, T Shinozaki

  • 1Department of Anesthesiology, University of Vermont Medical College, Burlington 05401, USA.

Critical Care Medicine
|November 21, 1998
PubMed
Summary
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Using the APACHE III score to withdraw ICU care for high-risk patients is not cost-effective unless its predictive power is validated in new settings. Further research is needed to justify this approach.

Area of Science:

  • Critical Care Medicine
  • Health Economics
  • Medical Decision Making

Background:

  • Withdrawing care in intensive care units (ICUs) involves complex clinical and ethical considerations.
  • Prognostic scoring systems aim to objectively predict patient outcomes, but their generalizability can be limited.

Purpose of the Study:

  • To assess the cost-effectiveness of using mortality risk estimates from the APACHE III score to guide decisions on withdrawing care in the ICU.
  • To compare this strategy against traditional subjective clinical criteria.

Main Methods:

  • A decision tree model was developed to compare two strategies: standard care withdrawal vs. care withdrawal based on APACHE III scores (>90% mortality risk at 48 hours).
  • Data from 4,106 noncardiac ICU patients were analyzed for transition probabilities.
Keywords:
APACHEDeath and EuthanasiaHealth Care and Public Health

Related Experiment Videos

  • Cost estimates were derived from Therapeutic Intervention Scoring System (TISS) scores and published production costs.

    • Main Results:

    • The strategy using APACHE III scores resulted in a slightly lower survival rate (86.85% vs. 87.2%) compared to subjective criteria.
    • The cost-per-death prevented (CPDP) was significantly higher ($263,700) without the scoring system in the base case.
    • Decreasing the specificity of the APACHE III score significantly reduced CPDP, highlighting the impact of predictive accuracy.

    Conclusions:

    • The use of APACHE III scores for withdrawing ICU care is unlikely to be cost-effective unless validated in external databases.
    • The incremental cost-effectiveness may not justify the use of these scores without proven external predictive power.