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  1. Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults.

    Article - En anglais

    Background 

    Renal failure requiring dialysis in the setting of hospitalization for serious illness is a poor prognostic sign, and dialysis and aggressive care are sometimes withheld.

    Objective 

    To evaluate the clinical outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care for seriously ill hospitalized patients.

    Design 

    Prospective cohort study and cost-effectiveness analysis.

    Setting 

    Five geographically diverse teaching hospitals.

    Patients 

    490 patients (median age, 61 years ; 58% women) enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) in whom dialysis was initiated.

    Measurements 

    Survival, functional status, quality of life, and health care costs.

    Life expectancy was estimated by extrapolating survival data (up to 4.4 years of follow-up) using a declining exponential function.

    Utilities (quality-of-life weights) were estimated by using time-tradeoff questions.

    Costs were based on data from SUPPORT and published Medicare data.

    Results 

    Median duration of survival was 32 days, and only 27% of patients were alive after 6 months.

    Survivors reported a median of one dependency in activities of daily living, and 62% rated their quality of life as « good » or better.

    Overall, the estimated cost per quality-adjusted life-year saved by initiating dialysis and continuing aggressive care rather than withholding dialysis and allowing death to occur was $128 200. (...)

    Mots-clés Pascal : Unité soin intensif, Etude cohorte, Coût, Dialyse, Soin palliatif, Evaluation, Pronostic, Homme, Réanimation, Organisation santé, Appareil urinaire pathologie, Rein pathologie

    Mots-clés Pascal anglais : Intensive care unit, Cohort study, Costs, Dialysis, Palliative care, Evaluation, Prognosis, Human, Resuscitation, Public health organization, Urinary system disease, Kidney disease

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0417236

    Code Inist : 002B27B03. Création : 19/12/1997.