10.1001/TESTjama.2012.4607

Vollständiger Abstract

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IMPORTANCE: The cost-effectiveness of remote rehabilitation for survivors following critical illness after intensive care unit (ICU) care is unknown. OBJECTIVE: To evaluate the cost-effectiveness of remote multicomponent rehabilitation compared with standard care following discharge from hospital after an ICU admission. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was conducted within a pragmatic, multicenter, assessor-blinded trial comparing remote rehabilitation delivered online with standard care after discharge from ICU from both National Health Service (NHS) and Personal Social Services (PSS) and societal perspectives over a 6-month time horizon. The trial was conducted from December 2022 to November 2025. The setting was 52 NHS hospitals in the United Kingdom. Participants were adults (aged ≥18 years) within 12 weeks of discharge from hospital that included an ICU admission for critical illness, requiring mechanical ventilation for 48 hours or longer. INTERVENTIONS: A remotely delivered rehabilitation program or standard care. MAIN OUTCOMES AND MEASURES: Costs including using questionnaires and microcosting approach (in 2024 UK pounds sterling) and quality-adjusted life-years (QALYs), derived directly from trial data, were calculated per group and reported in terms of incremental cost per QALY gained. RESULTS: A total of 429 participants (245 men [57%]; mean [SD] age, 55.4 [13.9] years) were enrolled, including 231 (54%) in the intervention group and 198 (46%) in the standard group. From a UK NHS-PSS perspective, the rehabilitation intervention was associated with increased mean costs (£1250; 95% CI, £562-£1938) and QALYs (0.023; 95% CI, 0.007-0.040) per participant, compared with the standard care group. Incremental cost-effectiveness ratio (ICER) was £54 034 per QALY. The probability of rehabilitation intervention being cost-effective was 3% and 11% at UK willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The intervention was cost-effective for patients with mechanical ventilation for 7 days or less (ICER, £21 476 per QALY) or if a societal perspective was adopted (ICER, £6341 per QALY). CONCLUSIONS AND RELEVANCE: In this economic analysis, among ICU survivors overall, a remotely delivered multicomponent rehabilitation program was not cost-effective from a UK NHS-PSS perspective. Cost-effectiveness was more favorable from a societal perspective and for patients receiving mechanical ventilation for 7 days or less. For rehabilitation interventions to be both clinically and cost-effective a precision medicine approach to medical and psychosocial health care interventions is needed once patients are home from hospital.

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