目的:确定体外心肺复苏(E-CPR)护理周期的实际成本和成本驱动因素。
结论:从医疗保健提供者的角度进行的基于时间驱动的基于活动的成本核算研究。
方法:澳大利亚一家四级护理ICU,为院外心脏骤停(OHCA)和院内心脏骤停(IHCA)提供全天候E-CPR服务。
方法:E-CPR护理周期定义为从开始E-CPR到患者出院或死亡的时间。开发了具有离散步骤和概率决策节点的详细过程图,以说明E-CPR患者的复杂轨迹。每个过程多次收集有关临床和非临床资源以及活动时间的数据。使用所有临床和非临床资源的时间估计和每个资源的单位成本来计算总直接成本。将总的直接成本与间接成本相结合,以获得E-CPR的总成本。
结果:从研究期间观察到的10个E-CPR护理周期,每个过程至少获得3个观察结果。E-CPR护理周期的平均费用(95%CI)为75,014美元(66,209-83,222美元)。体外膜氧合(ECMO)的启动和ECMO管理占成本的18%。ICU管理(35%)和手术费用(20%)是主要的费用决定因素。IHCA的平均成本(95%CI)高于OHCA(87,940美元[75,372-100,570]与62,595[53,994-71,890],p<0.01),主要是因为IHCA患者的生存率和ICU住院时间增加。每位E-CPR幸存者的平均费用为129,503美元(112,422-147,224美元)。
结论:对于难治性心脏骤停,E-CPR的费用较高。与OHCA的E-CPR成本相比,IHCA的E-CPR成本更高。E-CPR费用的主要决定因素是ICU和手术费用。这些数据可以为未来E-CPR的成本效益分析提供信息。
OBJECTIVE: To determine the actual cost and drivers of the cost of an extracorporeal cardiopulmonary resuscitation (E-CPR) care cycle.
CONCLUSIONS: A time-driven activity-based costing study conducted from a healthcare provider perspective.
METHODS: A quaternary care ICU providing around-the-clock E-CPR service for out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) in Australia.
METHODS: The E-CPR care cycle was defined as the time from initiating E-CPR to hospital discharge or death of the patient. Detailed process maps with discrete steps and probabilistic decision nodes accounting for the complex trajectories of E-CPR patients were developed. Data about clinical and nonclinical resources and timing of activities was collected multiple times for each process . Total direct costs were calculated using the time estimates and unit costs per resource for all clinical and nonclinical resources. The total direct costs were combined with indirect costs to obtain the total cost of E-CPR.
RESULTS: From 10 E-CPR care cycles observed during the study period, a minimum of 3 observations were obtained per process. The E-CPR care cycle\'s mean (95% CI) cost was $75,014 ($66,209-83,222). Initiation of extracorporeal membrane oxygenation (ECMO) and ECMO management constituted 18% of costs. The ICU management (35%) and surgical costs (20%) were the primary cost determinants. IHCA had a higher mean (95% CI) cost than OHCA ($87,940 [75,372-100,570] vs. 62,595 [53,994-71,890], p < 0.01), mainly because of the increased survival and ICU length of stay of patients with IHCA. The mean cost for each E-CPR survivor was $129,503 ($112,422-147,224).
CONCLUSIONS: Significant costs are associated with E-CPR for refractory cardiac arrest. The cost of E-CPR for IHCA was higher compared with the cost of E-CPR for OHCA. The major determinants of the E-CPR costs were ICU and surgical costs. These data can inform the cost-effectiveness analysis of E-CPR in the future.