RESUMO
The clinical courses of 106 patients with limb-threatening ischemia were traced for as long as 5 years to determine the cost of their care. Seventy-eight patients initially treated with vascular reconstruction accrued an average of $40,769 +/- $3726 in costs over a mean follow-up period of 805 +/- 57 days, during which they had an average of 2.4 +/- 0.2 hospitalizations or 67 +/- 6 inpatient days. Twenty-eight high-risk patients treated with primary amputation accrued $40,563 +/- $4729 in costs over a mean follow-up period of 663 +/- 97 days, during which they had an average of 2.2 +/- 0.3 hospitalizations or 85 +/- 10 inpatient days. Successful revascularization resulted in lower costs ($28,374) than did primary amputation ($40,563) or failed reconstruction ($56,809). Patients with ischemic tissue loss accrued costs more rapidly than did patients with rest pain only. The high cost of providing care for these patients and the advent of diagnosis related group reimbursement mandate that proposed treatment protocols be evaluated not only for their effectiveness but also for their cost-effectiveness.
Assuntos
Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/economia , Análise Atuarial , Idoso , Amputação Cirúrgica/economia , Análise Custo-Benefício , Custos e Análise de Custo , Grupos Diagnósticos Relacionados/economia , Feminino , Seguimentos , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores de TempoRESUMO
The hospital costs and its respective components for 32 patients with acute variceal bleeding were determined. The average total cost for treating the 32 patients was $35,000. The cost for those patients who underwent elective surgery ($53,000) was approximately twofold that of the elective medical group. Nutritional and metabolic rehabilitation that prolonged hospitalization, reutilization of the intensive care unit, and perioperative blood requirements were the significant factors that increased the cost of treating the surgically treated patients. Derivation of the cost/benefit ratio, however, showed that the decreased rehospitalization rate of the surgically treated group and the apparent better "quality of life" almost offset the increased initial hospital costs for this group.