I was walking the dog&while she was busy outrunning a doberman and a german shepherd puppy I was thinking about value for money and whether we, on the ICU, did some good in the economic sense during the #covid19 surge. I'm going off on a limb, so please feel free to correct me!
My health economics are very rudimentary, so anyone with a bit of knowledge will see the gaping holes. Please educate me :). The calculations are far from exact, mostly illustrative and rounded up or down so I could do maths easily in my head. This is what I came up with:
Our unit had 35 #COVID19 survivors out of 52 admissions. They were young, with average age of ~56 years. Let's assume that each survivor has 20 QUALY each = 700 QUALY. I then took a wild guess and said 1 QUALY after ICU is ~£20,000 as this is the NICE cutoff I remember.
This means the "value added" by our care is ~£14,000,000. There were a lot of us making sure we actually realise this "value added", again a wild guess of about 70 docs of different specialties & 130 nurses/AHPs, make it 200 people. On average, each of us produced ~£70,000 value
As I said it was all done while walking the dog, so didn't adjust for nuances about value for decision making and executing tasks, or drilling down to different tasks and complexity of interventions. Still, it's pretty astonishing, that we all "produced" this much of value!
Once home, I checked some figures. We know that cost-effectiveness increases if we save patients where predicted mortality is >40% ccforum.biomedcentral.com/articles/10.11… which was certainly true in ventilated #COVID19 patients.
We also know that ICU survivors accumulate significantly less number of QUALYs over the years, however the cohorts studied are not representative of our #COVID19 population ccforum.biomedcentral.com/articles/10.11… When looking at ARDS in specific jintensivecare.biomedcentral.com/articles/10.11… this is even worse at 0.31
So I might have severely overestimated the QUALYs which will be gained by our patients, reducing the "value" created. Other issue is to attach £££ to QUALYs, the most recent data I found was an abstract journals.lww.com/ccmjournal/Cit… which looked at health utility+resource utilisation
They estimated from previous data, that for previously employed patients (vast majority of our #COVID19 population the healthy utility and QUALY gain was 0.77 compared to the general population.
We know from our yet unpublished, but presented work that healthcare use is significantly increases for critical care survivors journals.lww.com/ccmjournal/Cit… and that secondary healthcare utilisation is 3x more for ICU survivors epostersonline.com/soa2019/node/1…
So using the data from McLaughlin et al. the cost of QUALY is around $25k=£20k if the health utility of ICU is indeed 0.77. (If this is closer to 0.31 as the ARDS studies suggest, then the cost of QUALY goes up to ~£50k!)
Finally, the life expectancy of a 56 years old male is 24.72 years and for a 56 years old female is 27.99 years, so at 0.77 health utility we get 19 and 21.5 years, call it 20...
So it seems my calculations while walking the dog might be correct?
So it seems my calculations while walking the dog might be correct?
If this is the case, we have produced an astonishing value over the 10-12 weeks on our unit and when you extrapolate this to the whole of the UK, we might just have done something good, in economical terms as well.
