心肺停止後の医療コスト、長期生存、QOL・・・

日本の医学で致命的に遅れているのは、Life Qualify測定である。客観性のない感情論が跋扈する日本でもっとも重要だとおもうのだが・・・Survey Short Form-36 questionnaire (SF-36)なんてやる気があればさほどむずかしくもないのだが・・・(手間はかかるが・・)


Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest
Critical Care 2008, 12:R92doi:10.1186/cc6963

358名中110名5年生存(31%)
5年生存者の平均健康状態は0.77(95%CI 0.70-0.85)
女性のHR-QOLは男性より良好(0.87 versus 0.74; P < 0.05)
生存者退院あたりのコスト 49,952 €
退院後コストを含めると、年あたり総コスト0,107 €.

人年コスト5年生存限定で考えると、年あたり加算コストは9,816 €で、QALYあたりで14,487 €

重症の神経的合併症7名を含むと、5年生存者では人年コストは18%増加で、」11,566 €.





Health-related quality of life (HRQL) was obtained 5 years after ICU discharge using a regular mail formal letter, including a return envelope, containing the validated German interview form of the Medical Outcome Survey Short Form-36 questionnaire (SF-36) self-report form .

In addition, the questionnaire assessed employment and marital status, dependency, re-hospitalizations, patients' recollection of their ICU stay, and their willingness to undergo critical care, if necessary, again.

If patients did not respond to the questionnaire and telephone contact could not be established, the family doctor and/or relatives of the patients were contacted to provide the correct address of the patient or to confirm death after hospital discharge.

Patients who could not be contacted, but were known to be alive, were considered lost to follow-up with regard to HRQL. Normative HRQL data, including apparently healthy controls and patients with acute and chronic diseases , are available for different age groups of the German population.

An HSI, which represents overall quality of life relative to an age-matched reference group, was calculated for each patient using the SF-36 results.

The HSI is a weight ranging from 0 (indifference between life and death) to 1 (perfect health) and was calculated for each patient as the mean of the individual domain indices for the eight domains of the SF-36 (that is, by dividing the individual patient result for a particular domain by the domain mean of the normative data obtained from apparently healthy Germans , summing each domain index, and dividing by the number of domains).

The HSI multiplied by life years gained results in QALYs [17]. Patients discharged from the hospital with a Glasgow Coma Scale (GCS) score of below 6 points (that is, severely neurologically disabled patients) were analyzed separately since formal objective quality-of-life assessment was not possible.

by internalmedicine | 2008-07-26 09:36 | 動脈硬化/循環器  

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