集中治療室の高齢患者のための機械呼吸器. 漸進的な変化と利益
I L Cohen1, J Lambrinos, I A Fein
1Department of Surgery, Albany Medical College, NY 12208.
JAMA
|February 24, 1993
まとめ
80歳以上のICUの患者のための長期にわたる機械呼吸器は,特に年齢と呼吸器の日数が100日を超えると,費用対効果が高くありません. 病院料金と救助された寿命の分析は,臨床的および管理的決定のための洞察を提供します.
科学分野:
- クリティカルケア・メディシン
- 健康経済学 医療経済学
- ゲリアトリック・メディシン (老年医学)
背景:
- 長期にわたる機械呼吸は,集中治療室 (ICU) での資源密集的な介入です.
- 高齢者集団におけるこのような介入の費用対効果を評価することは,リソースの配分と臨床的意思決定において極めて重要です.
- 80歳以上の患者は,独特の医療ニーズとアウトカムを持つ成長する人口を代表しています.
研究 の 目的:
- 80歳以上の重症病棟 (ICU) の患者の長期の機械呼吸器の費用対効果を評価する.
- この特定の高齢者コホートにおける機械換気に関連した経済的影響と節約された寿命を決定する.
- 重症高齢患者の換気戦略に関する臨床的および管理的意思決定に役立つデータを提供する.
主な方法:
- 80歳以上のICUの45人のICU患者で,少なくとも3日間,機械呼吸器を必要とした後のレビュー.
- 増額された病院料金と救われた命の年数に基づいた費用対効果分析.
- 病院での生存者のフォローアップは,少なくとも4年間,電話調査を通じて行われました.
主要な成果:
- 45人の患者のうち10人だけが入院後に生存し,1人だけがフォローアップ時に生きていた.
- 節約された生命の1年間の推定コストは,51,854ドルから75,090ドル (1985年-1987年のドル) であった.
- 年齢と換気日数が100日を超えた患者の場合,救出された命の年間費用は1,181,308ドルであり,追跡調査では生存者はいなかった.
結論:
- 80歳以上のICU患者の長期間にわたる機械呼吸は,特に年齢と呼吸時間の合計が100を超えると,費用対効果が低いことを示しています.
- この調査結果は,この人口集団の現在の換気戦略が,経済的効率性や長期的な生存効果と一致しない可能性があることを示唆しています.
- 機械呼吸器を必要とする重症高齢患者の管理における臨床的および管理的決定を導くために,さらなる費用対効果の分析が推奨されます.
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