Presentation (CTI)

OBJECTIVES: Intensive care medicine is resource-intensive, yet evidence relating healthcare costs to long-term health outcomes across broad intensive care unit (ICU) populations remains limited. This study aimed to describe cost per quality-adjusted life year (QALY) up to five years after ICU admission among ICU survivors.
METHODS: In this study across 11 Dutch hospitals, data from MONITOR-IC ICU survivors admitted between July 2016 and December 2023 were linked to the Dutch National Intensive Care Evaluation registry and a nationwide health insurance claims database. Healthcare costs were obtained for up to five years after ICU admission. Health-related quality of life (HRQoL) was assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire at ICU admission and at 1, 2, and 5 years. QALYs were derived by combining HRQoL with survival data. Cost per QALY was calculated over 1-, 2-, and 5-year follow-up in the total cohort and predefined clinically relevant subgroups.
RESULTS: A total of 11,760 ICU survivors were included. Cost per QALY among cardiothoracic surgery ICU survivors was €40,671, €24,147, and €13,917 at 1, 2, and 5 years. Corresponding values among non-cardiothoracic surgery ICU survivors were €79,335, €47,381, and €29,009, respectively. Subgroup analyses demonstrated substantial variation in cost per QALY. Chronic dialysis, hematological malignancy, and chronic obstructive pulmonary disease consistently had the highest cost per QALY across follow-up. At 1 year, values were €149,601, €143,357, and €115,640, respectively.
CONCLUSIONS: Cost per QALY was higher among non-cardiothoracic surgery ICU survivors than among cardiothoracic surgery ICU survivors. Cost per QALY decreased between 1, 2, and 5 years after ICU admission, highlighting the importance of long-term follow-up in economic evaluations after intensive care. Higher cost per QALY among ICU survivors with chronic comorbidities reflects the substantial long-term healthcare burden of these conditions.