Cost-Effective Critical Care: Cost Containment and Rationing

被引:12
作者
Rubenfeld, Gordon D. [1 ,2 ]
机构
[1] Sunnybrook Hlth Sci Ctr, Dept Med, Toronto, ON M4N 3M5, Canada
[2] Univ Toronto, Dept Med, Sch Med, Toronto, ON, Canada
关键词
cost containment; rationing; critical care; ethics; resources; CENTRAL VENOUS CATHETERS; INTENSIVE-CARE; MECHANICAL VENTILATION; UNITED-STATES; LIFE-SUPPORT; PREVENTION; OREGON; GUIDE; PRINCIPLES; ALLOCATION;
D O I
10.1055/s-0032-1322411
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationing occurs whenever the demand for a good or service exceeds its supply. Therefore rationing is an inevitable occurrence in medicine and in critical care where the potential demand for effective medical care will exceed supply. Although there are many strategies to allocate medical resources one that is often considered is based on cost-effectiveness. Cost-effectiveness analysis attempts to estimate the value of individual medical treatments in terms of dollars and outcomes. Allocation of medical treatments based on cost-effectiveness analysis requires valid estimates of both the costs and the effectiveness of treatments as well as some overarching body with the authority to enforce allocation based on these analyses. Limitations of allocation based on cost-effectiveness analysis in critical care include difficulties in estimating marginal costs of critical care treatments, limited evidence for any treatments with efficacy, and the ethical principle of rescuing identifiable lives in imminent risk of death. The prospect of a pandemic influenza-like infection has stimulated a lot of interest in hypothetical rationing strategies for the intensive care unit, none of which has been tested in actual pandemic scenarios. Given the burden of critical illness and the wide variation in resources a global approach to rationing is untenable. The article concludes with a vision of the future of allocation in critical care.
引用
收藏
页码:413 / 420
页数:8
相关论文
共 44 条
  • [1] Critical Care 1 Critical care and the global burden of critical illness in adults
    Adhikari, Neill K. J.
    Fowler, Robert A.
    Bhagwanjee, Satish
    Rubenfeld, Gordon D.
    [J]. LANCET, 2010, 376 (9749) : 1339 - 1346
  • [2] Alexander S., 1962, LIFE, V43, P102
  • [3] [Anonymous], COCHRANE DATABASE SY
  • [4] Rationing by any other name
    Asch, DA
    Ubel, PA
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (23) : 1668 - 1671
  • [5] Prophylaxis for stress-related gastrointestinal hemorrhage: A cost effectiveness analysis
    BenMenachem, T
    McCarthy, BD
    Fogel, R
    Schiffman, RM
    Patel, RV
    Zarowitz, BJ
    Nerenz, DR
    Bresalier, RS
    [J]. CRITICAL CARE MEDICINE, 1996, 24 (02) : 338 - 345
  • [6] The Oregon Health Plan - Lessons for the nation .1.
    Bodenheimer, T
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (09) : 651 - 655
  • [7] Brook R H, 1986, Int J Technol Assess Health Care, V2, P53
  • [8] Critical care triage
    Christian, Michael D.
    Joynt, Gavin M.
    Hick, John L.
    Colvin, John
    Danis, Marion
    Sprung, Charles L.
    [J]. INTENSIVE CARE MEDICINE, 2010, 36 : S55 - S64
  • [9] A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic
    Christian, Michael D.
    Hamielec, Cindy
    Lazar, Neil M.
    Wax, Randy S.
    Griffith, Lauren
    Herridge, Margaret S.
    Lee, David
    Cook, Deborah J.
    [J]. CRITICAL CARE, 2009, 13 (05)
  • [10] A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation
    Cook, D
    Guyatt, G
    Marshall, J
    Leasa, D
    Fuller, H
    Hall, R
    Peters, S
    Rutledge, F
    Griffith, L
    McLellan, A
    Wood, G
    Kirby, A
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (12) : 791 - 797