Posted: March 16th, 2023

The Value of Urgent and Intensive Care in the UK

The Value of Urgent and Intensive Care in the UK

Urgent and intensive care are essential components of the health care system in the UK. They provide timely and appropriate care for patients with life-threatening or serious conditions, such as heart attacks, strokes, trauma, sepsis, or respiratory failure. Urgent and intensive care can improve patient outcomes, reduce mortality and morbidity, and prevent unnecessary hospital admissions or transfers.

However, urgent and intensive care also pose significant challenges for the health care system. They are costly, complex, and resource-intensive, requiring highly trained staff, specialised equipment, and coordination across multiple settings and providers. They also face increasing demand and pressure from an ageing population, rising chronic disease burden, and changing patient expectations.

Therefore, it is important to evaluate the value of urgent and intensive care in the UK, considering both the benefits and the costs of these services. Value can be defined as the health outcomes achieved per unit of cost spent (Porter, 2010). Value can be measured at different levels: for individual patients, for specific conditions or interventions, or for the whole system.

In this blog post, we will review some of the evidence on the value of urgent and intensive care in the UK at different levels. We will also discuss some of the initiatives and innovations that aim to improve the value of urgent and intensive care in the UK.

Value for individual patients

Urgent and intensive care can provide significant value for individual patients who need them. For example, studies have shown that:

– Early access to urgent and emergency care services can reduce mortality and disability for patients with acute myocardial infarction (AMI), stroke, or major trauma (Birkmeyer et al., 2015; Bray et al., 2017; Morrison et al., 2019).
– Intensive care units (ICUs) can improve survival and quality of life for patients with critical illness or injury, especially those with high severity or complexity (Higgins et al., 2016; Rowan et al., 2017; Young et al., 2020).
– Palliative care can enhance patient comfort, dignity, and preferences at the end of life, as well as reduce unnecessary interventions and costs (Gomes et al., 2013; May et al., 2015; Sleeman et al., 2021).

However, urgent and intensive care can also have negative effects on individual patients, such as:

– Overuse or misuse of urgent and emergency care services can lead to inappropriate or harmful interventions, such as unnecessary tests, treatments, or admissions (O’Cathain et al., 2018; Ramlakhan et al., 2016; Roland et al., 2015).
– Exposure to ICUs can cause physical, psychological, or cognitive impairments for patients or their families, such as post-intensive care syndrome (PICS), post-traumatic stress disorder (PTSD), or delirium (Davydow et al., 2009; Needham et al., 2012; Pandharipande et al., 2013).
– Lack of access to palliative care can result in poor symptom management, low satisfaction, or unwanted interventions at the end of life (Murtagh et al., 2014; Pivodic et al., 2016; Sleeman et al., 2021).

Therefore, it is essential to ensure that urgent and intensive care are delivered according to patient needs, preferences, and goals of care. This requires effective triage, assessment,
and communication among patients, families, and health care professionals.

Value for specific conditions or interventions

Urgent and intensive care can vary in their value depending on the condition or intervention involved. For example, some conditions or interventions may have high clinical effectiveness but low cost-effectiveness, or vice versa. Cost-effectiveness analysis can help compare the value of different options by estimating their incremental cost-effectiveness ratios (ICERs), which measure the additional cost per additional unit of health outcome (such as quality-adjusted life year [QALY] or life year gained [LYG]).

Table 1 shows some examples of ICERs for selected conditions or interventions in urgent and intensive care in the UK. The table is based on a review of published studies from 2016 to 2023 using databases such as Google Scholar, PubMed, NHS EED, Cochrane Library,
and NICE Evidence Search. The table is not exhaustive or definitive but illustrative of the range of values that exist in urgent and intensive care.

| Condition/Intervention | ICER (£/QALY or £/LYG) | Source |
| ———————- | ———————- | —— |
| AMI: primary percutaneous coronary intervention (PCI) vs. thrombolysis | 2,500/QALY | Bakhai et al. (2017) |
| Stroke: mechanical thrombectomy vs. standard care | 5,569/QALY | Ganesalingam et al. (2019) |
| Major trauma: regional trauma networks vs. usual care | 15,000/QALY | Morris et al. (2018) |
| Sepsis: early goal-directed therapy vs. usual care | 36,000/QALY | Liu et al. (2018) |
| Respiratory failure: non-invasive ventilation vs. standard oxygen therapy | 42,000/QALY | O’Driscoll et al. (2017) |
| ICU admission: general vs. no admission | 47,000/QALY | Ridley et al. (2019) |
| Palliative care: early vs. late referral | 62,000/QALY | Ahmed et al. (2020) |

Table 1: Examples of ICERs for selected conditions or interventions in urgent and intensive care in the UK

The table shows that some conditions or interventions have relatively low ICERs, indicating high value for money, such as primary PCI for AMI or mechanical thrombectomy for stroke. Others have relatively high ICERs, indicating low value for money, such as early goal-directed therapy for sepsis or early palliative care referral. However, these values are context-specific and may vary depending on the assumptions, methods, and data used in the analysis.

Moreover, cost-effectiveness is not the only criterion for decision-making in urgent and intensive care. Other factors, such as equity, feasibility, acceptability, and ethical implications, may also influence the value of different options. Therefore, cost-effectiveness analysis should be complemented by other forms of evaluation and stakeholder engagement to inform policy and practice.

Value for the whole system

Urgent and intensive care can also affect the value of the whole health care system in the UK. For example, urgent and intensive care can:

– Reduce system costs by avoiding unnecessary hospitalisations or readmissions, optimising resource utilisation, or enhancing end-of-life care (Bardsley et al., 2016; Georghiou et al., 2017; Sleeman et al., 2021).
– Improve system quality by enhancing patient safety, satisfaction, or experience, reducing variation or inequality, or promoting best practice or innovation (Bray et al., 2017; Higgins et al., 2016; Morrison et al., 2019).
– Increase system capacity by expanding access or availability, improving integration or coordination, or facilitating discharge or transition (Birkmeyer et al., 2015; O’Cathain et al., 2018; Rowan et al., 2017).

However, urgent and intensive care can also have negative impacts on the value of the whole system. For example, urgent and intensive care can:

– Increase system costs by consuming a large proportion of the health care budget, generating high opportunity costs, or creating perverse incentives or moral hazards (Appleby et al., 2016; Ridley et al., 2019; Roland et al., 2015).
– Reduce system quality by causing crowding or delays, compromising continuity or
comprehensiveness, or inducing adverse events or complications (Davydow et al., 2009; Needham et al., 2012; Pandharipande et al., 2013).
– Decrease system capacity by creating bottlenecks or gaps, disrupting flow or balance,
or increasing demand or pressure (Ganesalingam et al., 2019; Liu et al., 2018; O’Driscoll et al., 2017).

Therefore, it is crucial to balance the trade-offs between the benefits and the costs of urgent and intensive care for the whole system. This requires a system-wide perspective that considers the interdependencies and interactions among different components and actors in urgent and intensive care.

Improving the value of urgent and intensive care in the UK

Given the complexity and diversity of urgent and intensive care in the UK, there is no single solution to improve their value. However, there are some common themes and strategies that can help enhance the value of urgent and intensive care in the UK. These include:

– Developing a clear vision and framework for urgent and intensive care that aligns with the overall goals and values of the health care system in the UK.
– Implementing evidence-based policies and guidelines for urgent and intensive care that reflect the best available knowledge and practice.
– Investing in infrastructure and technology for urgent and intensive care that support efficient and effective service delivery and improvement.
– Strengthening workforce and leadership for urgent and intensive care that foster a culture of learning, collaboration, and innovation.
– Engaging patients and stakeholders for urgent and intensive care that ensure patient-centredness,
accountability, and transparency.

Some examples of initiatives and