Browsing by Author "Malmivaara, Kirsi"

Aims: The overall purpose of this study was to evaluate the health-related quality of life (HRQoL) and cost-effectiveness of the treatment of severely, acutely ill neurosurgical patients. The majority of the study illnesses and conditions are known to have a relatively high mortality or an otherwise poor outcome but, they are also known to be highly resource-demanding. Since the economics of health care is attracting more and more interest, it will become more important to evaluate the cost-effectiveness of treatment so that it can be demonstrated that the resource allocation is justified. Methods: The patients (n=620) for these four separate studies were treated in the Department of Neurosurgery of Helsinki University Central Hospital between 1998 and 2006. The first of these four studies was a Step-Down Unit study in which we evaluated a group of patients (n=346) who underwent a major neurosurgical operation and were treated in the neurosurgical intensive care unit (NICU) and, due to a poor prognosis, were then discharged from the NICU to the step-down unit, still depending on life support devices. The following two studies evaluated patients who underwent a decompressive craniectomy (DC) for intractable intracranial pressure. The first of these, the DC after SAH study, concerned patients (n=42) with subarachnoid haemorrhage (SAH) or other neurological emergencies, and the second one, the DC after TBI study, evaluated patients (n=54) with traumatic brain injury (TBI). The fourth study, the SAH study (n=178), evaluated the long-term outcome, HRQoL and cost-effectiveness of the treatment of the SAH patients. Results: The mortality in the Step-Down Unit study and both of the DC studies was high and moderate in the SAH study, 59%, 53%, 41%, and 24% respectively. The median follow-up times were 5, 3, 5.6 and 10.8 years. The health-related quality of life was assessed with the EuroQol EQ5D instrument and the median HRQoL index was compared to the median index of the Finnish reference population (0.85). The indices were 0.71, 0.41, 0.85 and 1.00. The outcome was also evaluated on the Glasgow outcome scale (GOS), and 49%, 25%, 69% and 75% of the patients achieved a good outcome (GOS 1-2). An important measure of well-being is the ability to live at home, and 49%, 50%, 78% and 88% of the study patients were able to live at home. The direct costs of the neurosurgical treatment per quality adjusted life year (QALY) were 2521€, 5000€, 2400€ and 1700€. Conclusions: For the total of 620 severely ill neurosurgical patients treated in the Helsinki Department of Neurosurgery between 1998 and 2006, we found the treatment to be cost-effective, and it resulted in health-related quality of life that varied from acceptable to good when compared to the reference population. We found no evidence of unnecessary prolongation of human suffering when death was inevitable. The worst state of health-related quality of life did not occur among the survivors. In summary, these studies indicate that current healthcare resources are utilized cost-effectively to achieve a life that is meaningful. Allocation of healthcare resources to the severely ill neurosurgical patients seems to be justified.