G Muñoz-Rojas1, B García-Lorenzo2,3, D Esteve4, S Trias5, D Caellas6, M Sanz7, R Mellado1,8, T Peix5, L Sampietro-Colom2, N Pou5, G Martínez-Pallí1,8, Carlos Ferrando9,10. 1. Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain. 2. Assessment of Innovations and New Technologies Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 3. Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain. 4. Respiratory Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain. 5. Surgical Area Management, Hospital Clínic de Barcelona, Barcelona, Spain. 6. Information Systems Management, Hospital Clínic de Barcelona, Barcelona, Spain. 7. Infrastructure Management, Hospital Clínic de Barcelona, Barcelona, Spain. 8. CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid, Spain. 9. Department of Anesthesiology and Critical Care, Hospital Clínic de Barcelona, Institut D'investigació August Pi i Sunyer, C/ Villarroel 170, 08036, Barcelona, Spain. cmferrando@clinic.cat. 10. CIBER (Center of Biomedical Research in Respiratory Diseases), Instituto de Salud Carlos III, Madrid, Spain. cmferrando@clinic.cat.
Abstract
PURPOSE: The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital. METHODS: We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon. RESULTS: 42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year. CONCLUSIONS: The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.
PURPOSE: The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital. METHODS: We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon. RESULTS: 42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year. CONCLUSIONS: The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.
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