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.
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Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Adhikari, Neill K. J.
Fowler, Robert A.
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Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Fowler, Robert A.
Bhagwanjee, Satish
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Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98195 USASunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Bhagwanjee, Satish
Rubenfeld, Gordon D.
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Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
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UNIV CALIF SAN FRANCISCO,SCH MED,DEPT FAMILY & COMMUNITY MED,SAN FRANCISCO,CA 94143UNIV CALIF SAN FRANCISCO,SCH MED,DEPT FAMILY & COMMUNITY MED,SAN FRANCISCO,CA 94143
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Univ Toronto, Div Infect Dis & Crit Care, Dept Natl Def, Canadian Forces & Dept Med,Mt Sinai Sch, Toronto, ON, CanadaHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Christian, Michael D.
Joynt, Gavin M.
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Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Prince Wales Hosp, Sha Tin, Hong Kong, Peoples R ChinaHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Joynt, Gavin M.
Hick, John L.
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Hennepin Cty Med Ctr, Dept Emergency Med, Minneapolis, MN 55415 USAHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Hick, John L.
Colvin, John
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Ninewells Hosp, Dept Anaesthesiol, Dundee DD1 9SY, ScotlandHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Colvin, John
Danis, Marion
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NIH, Dept Bioeth, Ctr Clin, Bethesda, MD 20892 USAHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Danis, Marion
Sprung, Charles L.
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Hadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, IsraelHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
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Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Adhikari, Neill K. J.
Fowler, Robert A.
论文数: 0引用数: 0
h-index: 0
机构:
Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Fowler, Robert A.
Bhagwanjee, Satish
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h-index: 0
机构:
Univ Washington, Dept Anesthesiol & Pain Med, Seattle, WA 98195 USASunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Bhagwanjee, Satish
Rubenfeld, Gordon D.
论文数: 0引用数: 0
h-index: 0
机构:
Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
Univ Toronto, Interdept Div Crit Care, Toronto, ON, CanadaSunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON M4N 3M5, Canada
机构:
UNIV CALIF SAN FRANCISCO,SCH MED,DEPT FAMILY & COMMUNITY MED,SAN FRANCISCO,CA 94143UNIV CALIF SAN FRANCISCO,SCH MED,DEPT FAMILY & COMMUNITY MED,SAN FRANCISCO,CA 94143
机构:
Univ Toronto, Div Infect Dis & Crit Care, Dept Natl Def, Canadian Forces & Dept Med,Mt Sinai Sch, Toronto, ON, CanadaHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Christian, Michael D.
Joynt, Gavin M.
论文数: 0引用数: 0
h-index: 0
机构:
Chinese Univ Hong Kong, Dept Anesthesia & Intens Care, Prince Wales Hosp, Sha Tin, Hong Kong, Peoples R ChinaHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Joynt, Gavin M.
Hick, John L.
论文数: 0引用数: 0
h-index: 0
机构:
Hennepin Cty Med Ctr, Dept Emergency Med, Minneapolis, MN 55415 USAHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Hick, John L.
Colvin, John
论文数: 0引用数: 0
h-index: 0
机构:
Ninewells Hosp, Dept Anaesthesiol, Dundee DD1 9SY, ScotlandHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Colvin, John
Danis, Marion
论文数: 0引用数: 0
h-index: 0
机构:
NIH, Dept Bioeth, Ctr Clin, Bethesda, MD 20892 USAHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
Danis, Marion
Sprung, Charles L.
论文数: 0引用数: 0
h-index: 0
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Hadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, IsraelHadassah Hebrew Univ Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel