Assessing the Cost-Effectiveness of Emerging Therapies in the ICU

Abstract

Medical care in the United States and the developed world is increasingly under heightened financial and economic pressure to reduce cost yet maintain and even improve quality. Perhaps nowhere is this pressure more evident than in the critical care areas and intensive care units (ICUs). In part this arises from an awareness of the disproportionate amount of resources consumed by critical care patients and ICU services. American ICUs, for example, account for only 5-10% of all hospital beds yet they consume over 30% of scarce inpatient resources, a figure which according to some estimates accounts for approximately 1% of the nation's Gross Domestic Product (GDP). Although the total level of spending in terms of both actual numbers and percent of GDP is different for ICU services in other developed nations, this disproportionate level of spending nevertheless exists between cost of care in the ICU and resource consumption on the general medical and surgical ward.

However, concern over high cost is not the sole and perhaps not even the primary reason for increased scrutiny levied upon critical care. Cost concerns and budgetary issues wane if the resources which are expended yield the desired clinical benefits, in terms of higher survival and enhanced quality of life. Similarly, economic issues are magnified if there is a perception of waste and inefficiency, in that better outcomes could possibly have been attained with the same resources or even that fewer resources would have been required to attain the current level of benefit. The essence of this argument boils down to a matter of value, in terms of what one attains relative to the resources which are consumed. As health care rapidly shifts away from a fee-for-service environment to systems which embrace varying measures of economic accountability, there will be a heightened demand for quantitative approaches to technology assessment and the valuation of new and emerging therapies from a collective clinical and economic perspective. In the ICU environment, this has already occurred, due in large part to the dependence upon high technology and the ongoing evaluation of expensive therapies with still-to-be-proven benefit. This paper will discuss methods and approaches often employed for the evaluation of emerging technologies, with an emphasis upon cost-effectiveness analysis, pharmacoeconomics, and related techniques.

Key Words:

ICU - gross domestic product - cost-effectiveness