Cost and outcome of mechanical ventilation for life-threatening stroke

Stephan A. Mayer, Daphne Copeland, Gary L. Bernardini, Bernadette Boden-Albala, Laura Lennihan, Sharon Kossoff, Ralph L. Sacco

Research output: Contribution to journalArticle

Abstract

Background and Purpose - Hospital mortality rates of 50% to 90% have been reported for stroke patients treated with mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among ventilated patients, and evaluate the cost-effectiveness of this intervention. Methods - We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and quality-adjusted life-year saved using a zero-cost, zero-life assumption. Results - Ten percent of patients (n=52) were mechanically ventilated. Thirty-day mortality was 65% overall and did not differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P<0.01) and subsequent neurological deterioration (P=0.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical ventilation resulted in a net deficit of meaningful survival. Conclusions - Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for extending life but not for preserving quality of life.

Original languageEnglish (US)
Pages (from-to)2346-2353
Number of pages8
JournalStroke
Volume31
Issue number10
StatePublished - 2000

Fingerprint

Artificial Respiration
Stroke
Costs and Cost Analysis
Survival
Quality-Adjusted Life Years
Intubation
Cost-Benefit Analysis
Survivors
Mortality
Hospitalization
Quality of Life
Glasgow Coma Scale
Urban Population
Coma
Hospital Mortality
Logistic Models
Regression Analysis
Incidence

Keywords

  • Cerebrovascular disorders
  • Cost-benefit analysis
  • Critical care
  • Quality of life
  • Stroke outcome
  • Ventilators, mechanical

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Mayer, S. A., Copeland, D., Bernardini, G. L., Boden-Albala, B., Lennihan, L., Kossoff, S., & Sacco, R. L. (2000). Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke, 31(10), 2346-2353.

Cost and outcome of mechanical ventilation for life-threatening stroke. / Mayer, Stephan A.; Copeland, Daphne; Bernardini, Gary L.; Boden-Albala, Bernadette; Lennihan, Laura; Kossoff, Sharon; Sacco, Ralph L.

In: Stroke, Vol. 31, No. 10, 2000, p. 2346-2353.

Research output: Contribution to journalArticle

Mayer, SA, Copeland, D, Bernardini, GL, Boden-Albala, B, Lennihan, L, Kossoff, S & Sacco, RL 2000, 'Cost and outcome of mechanical ventilation for life-threatening stroke', Stroke, vol. 31, no. 10, pp. 2346-2353.
Mayer SA, Copeland D, Bernardini GL, Boden-Albala B, Lennihan L, Kossoff S et al. Cost and outcome of mechanical ventilation for life-threatening stroke. Stroke. 2000;31(10):2346-2353.
Mayer, Stephan A. ; Copeland, Daphne ; Bernardini, Gary L. ; Boden-Albala, Bernadette ; Lennihan, Laura ; Kossoff, Sharon ; Sacco, Ralph L. / Cost and outcome of mechanical ventilation for life-threatening stroke. In: Stroke. 2000 ; Vol. 31, No. 10. pp. 2346-2353.
@article{1aa6094f7d8f44f7a33229fbbc1bfebb,
title = "Cost and outcome of mechanical ventilation for life-threatening stroke",
abstract = "Background and Purpose - Hospital mortality rates of 50{\%} to 90{\%} have been reported for stroke patients treated with mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among ventilated patients, and evaluate the cost-effectiveness of this intervention. Methods - We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and quality-adjusted life-year saved using a zero-cost, zero-life assumption. Results - Ten percent of patients (n=52) were mechanically ventilated. Thirty-day mortality was 65{\%} overall and did not differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P<0.01) and subsequent neurological deterioration (P=0.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical ventilation resulted in a net deficit of meaningful survival. Conclusions - Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for extending life but not for preserving quality of life.",
keywords = "Cerebrovascular disorders, Cost-benefit analysis, Critical care, Quality of life, Stroke outcome, Ventilators, mechanical",
author = "Mayer, {Stephan A.} and Daphne Copeland and Bernardini, {Gary L.} and Bernadette Boden-Albala and Laura Lennihan and Sharon Kossoff and Sacco, {Ralph L.}",
year = "2000",
language = "English (US)",
volume = "31",
pages = "2346--2353",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Cost and outcome of mechanical ventilation for life-threatening stroke

AU - Mayer, Stephan A.

AU - Copeland, Daphne

AU - Bernardini, Gary L.

AU - Boden-Albala, Bernadette

AU - Lennihan, Laura

AU - Kossoff, Sharon

AU - Sacco, Ralph L.

PY - 2000

Y1 - 2000

N2 - Background and Purpose - Hospital mortality rates of 50% to 90% have been reported for stroke patients treated with mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among ventilated patients, and evaluate the cost-effectiveness of this intervention. Methods - We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and quality-adjusted life-year saved using a zero-cost, zero-life assumption. Results - Ten percent of patients (n=52) were mechanically ventilated. Thirty-day mortality was 65% overall and did not differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P<0.01) and subsequent neurological deterioration (P=0.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical ventilation resulted in a net deficit of meaningful survival. Conclusions - Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for extending life but not for preserving quality of life.

AB - Background and Purpose - Hospital mortality rates of 50% to 90% have been reported for stroke patients treated with mechanical ventilation. These data have raised serious questions about the cost-effectiveness of this intervention. We sought to determine how often stroke patients are mechanically ventilated, identify predictors of 30-day survival among ventilated patients, and evaluate the cost-effectiveness of this intervention. Methods - We identified mechanically ventilated patients in a population-based multiethnic cohort of 510 incidence stroke patients who were hospitalized between July 1993 and June 1996. Factors affecting 30-day survival were identified in a multiple logistic regression analysis. We calculated the cost per patient discharged alive, life-year saved, and quality-adjusted life-year saved using a zero-cost, zero-life assumption. Results - Ten percent of patients (n=52) were mechanically ventilated. Thirty-day mortality was 65% overall and did not differ significantly by stroke subtype. Glasgow Coma Scale score on the day of intubation (P<0.01) and subsequent neurological deterioration (P=0.02) were identified as predictors of 30-day mortality. The cost (1996 US dollars) of hospitalization per patient discharged alive was $89 400; the cost per year of life saved was $37 600; and the cost per quality-adjusted life-year saved was $174 200. Functional status of most survivors was poor; at 6 months, half were severely disabled and completely dependent. In a worst-case scenario of quality of life preferences, mechanical ventilation resulted in a net deficit of meaningful survival. Conclusions - Two thirds of mechanically ventilated stroke patients die during their hospitalization, and most survivors are severely disabled. Survival is particularly unlikely if patients are deeply comatose or clinically deteriorate after intubation. In our multiethnic urban population, mechanical ventilation for stroke was relatively cost-effective for extending life but not for preserving quality of life.

KW - Cerebrovascular disorders

KW - Cost-benefit analysis

KW - Critical care

KW - Quality of life

KW - Stroke outcome

KW - Ventilators, mechanical

UR - http://www.scopus.com/inward/record.url?scp=0033795628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033795628&partnerID=8YFLogxK

M3 - Article

C2 - 11022062

AN - SCOPUS:0033795628

VL - 31

SP - 2346

EP - 2353

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 10

ER -