Figure 1.
Flow chart of the computation process for lifetime costs and cost-per-QALY (quality-adjusted life year).
Figure 2.
Quality adjusted survival for patients undergoing PMV (prolonged mechanical ventilation) with partial cognition after adjustment for survival function (N = 50,481) with the utility values of quality of life measured with EQ-5D (N = 55).
The result of QALE (quality-adjusted life expectancy) of an average patient was 0.98 QALY by summing the areas under the quality-adjusted survival curve.
Figure 3.
The average lifetime healthcare expenditure paid by the National Health Insurance (NHI) for patients undergoing PMV.
(prolonged mechanical ventilation) was calculated by multiplying the monthly average paid by the NHI (N = 50,481) with the corresponding survival probability and then summed up throughout life, as indicated by the shaded areas of the upper panel. The lifetime out-of pocket expense for PMV patients was obtained by multiplying the monthly average out-of pocket expense (estimated by kernel smoothing method on a convenient sample of 165 patients) with the corresponding survival probability and then summed up (shaded areas of the lower panel). The expected lifetime cost of a PMV patient is the total sum of these two shaded areas.
Table 1.
Characteristics of patients undergoing prolonged mechanical ventilation (PMV) and 2 cross-sectional samples for assessing quality of life (QOL) and out-of-pocket expenses.
Table 2.
Lifetime cost and cost per QALY (quality-adjusted life year) for patients undergoing prolonged mechanical ventilation in Taiwan, stratified by underlying diseases (Dis.), with sensitivity analysis of quality-adjusted life expectancy (QALE) under different states of cognition.
Table 3.
Lifetime cost and cost per QALY (quality-adjusted life year) for patients undergoing prolonged mechanical ventilation in Taiwan, stratified by different co-morbidities and age, with sensitivity analysis of quality-adjusted life expectancy (QALE) under different states of cognition.
Figure 4.
Plot of association between the cost-per-QALY (quality-adjusted life year) gained and the lifetime cost for different diagnosis groups of PMV patients with partial cognition.
, stratified by different specific illnesses [○] and multiple co-morbidities (indicated by sub-age groups, <65[•], 65–74[▪], 75–84[▾], and >84[□] years old). The GDP (gross domestic product) of Taiwan in 2010 was 18,588 US dollars, below which the cost-per-QALY was considered as cost-effective; between 1–3 times the GDP per QALY gained was considered moderate cost-effective, and above 3 times the GDP per QALY gained was not cost-effective. The figure indicates there are many conditions showing a lifetime cost less than 3 times the GDP, although their costs-per-QALY were above that figure.