Health Economic Evaluations in Intensive Care: An Updated Systematic Review.

Abstract

Objectives: Intensive care is a critical but resource-intensive component of healthcare. Health economic evaluations, such as cost-effectiveness analyses (CEAs), offer valuable insights for decision-making by weighing the costs and benefits of various healthcare interventions. We aimed to identify and summarize the existing health economic evaluations within intensive care and identify areas for future research.

Data sources: We searched six academic databases to identify full health economic evaluations of ICU interventions published between 1993 and 2023. Databases included: Ovid (MEDLINE, Embase, and evidence based medicine (EBM) Reviews [Health Technology Assessments and National Health Service (NHS) Economic Evaluation Database]), EBSCO (CINAHL and EconLit), and Web of Science.

Study selection: Health economic evaluations of interventions for adult patients in the ICU were included. Economic evaluations include CEAs, cost-utility, cost-benefit, and cost-minimization analyses, while pediatric, animal and weaning center studies were excluded.

Data extraction: Data were extracted by two independent reviewers. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.

Data synthesis: We identified 219 relevant studies published between 1993 and 2023, with a significant rise in publications over the last decade. Most studies (97%) had good to excellent reporting quality. Incremental cost-effectiveness ratios (ICERs) ranged from dominant (more effective and less expensive) to $753,874 per life saved. ICERs for both cost per quality-adjusted life-years and cost per life-year gained ranged from dominant to dominated (more costly and less effective). Three studies (1%) were published in low- and middle-income countries (LMICs) and 58% of studies were modeling studies.

Conclusions: Despite the importance of economic evidence in healthcare decision-making, there is a relative scarcity of cost-effectiveness studies in intensive care compared with other medical fields. Available economic evaluations in intensive care are characterized by significant heterogeneity. The wide range of ICERs for life saved, life-years gained, and quality-adjusted life-years reflects the diversity of ICU patients, interventions, and evaluation methods. Future research in LMICs and increasing trial-based research is recommended.