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Development and application of a method for estimating daily case-mix adjusted costs of adult critical care units.

Hibbert, Clare Louis (2007) Development and application of a method for estimating daily case-mix adjusted costs of adult critical care units. PhD thesis, University of Sheffield.

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Patients referred for treatment in an adult critical care unit are in, or at imminent risk of developing single or multiple organ failure. Despite the high treatment costs, knowledge of the costs of care is limited. The aims of this thesis were to synthesise current knowledge about the different methods used to estimate costs and to develop and apply a method for estimating daily case-mix adjusted costs for developing a set of Healthcare Resource Groups (HRGs) and for use in a trial-based economic evaluation. HRGs were required to support the Department of Health's new policy on reimbursing adult critical care called 'Reforming NHS Financial Flows: Introducing Payment By Results'. A systematic review of 20 published studies provided the background to, and justification for the methods employed in two empirical studies. The first empirical study was performed in a single critical care unit and using very detailed data on individual patients evaluated factors that had the potential to correlate with daily costs of critical care. Univariate and multivariate statistical analyses were undertaken using two different data sets. Patients' daily organ supports were identified as the key 'cost generating events'. A prospective, observational, longitudinal multi-centre study involving a volunteer sample of 70 critical care units followed, where organ support data on 7,243 consecutive admissions and monthly data on critical care unit expenditure were collected. Different ways of modelling the organ support and expenditure data were explored. The overall R2 for the chosen model- the daily number of organs supported was 0.52. Daily organ support weights for the average daily costs of critical care were 0.577 for 0 or 1 organ supported, 1.137 for 2 organs supported and 1.156 for 3 or more organs supported. These weights were then applied to average daily costs estimated for patients recruited to a clinical trial of Extracorporeal Membrane Oxygenation (ECMO) vs. conventional therapy for severe, but potentially reversible, respiratory failure.

Item Type: Thesis (PhD)
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Identification Number/EthosID: uk.bl.ethos.443881
Depositing User: EThOS Import Sheffield
Date Deposited: 02 Nov 2016 09:27
Last Modified: 02 Nov 2016 09:27
URI: http://etheses.whiterose.ac.uk/id/eprint/15060

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