INTENSIVE care units (ICUs) are estimated to cost the Australian health care system $2.1 billion annually, with larger units with increased occupancy associated with lower costs per patient bed-day, according to the authors of a research letter published online today by the MJA.

Dr Edward Litton, an intensive care consultant at Fiona Stanley Hospital in Perth, and colleagues analysed data for Australian ICUs from the 2013/14 Critical Care Resources survey of the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resources Evaluation, which included questions on the major components of expenditure.

Participating ICUs reported annual costs for selected budget items and total ICU expenditure; capital expenditure, organisational overhead costs, and equipment costs were not included. The cost per patient bed-day, the annual cost per ICU bed, and total annual costs were calculated. Complete costing data were received from 36 ICUs in 36 hospitals, accounting for 500 ICU beds (about 25% of ICU beds in Australia).

“The mean cost per patient bed-day for all contributing ICUs [in 2013–2014] was $4375,” the authors wrote. Today in 2019, this would be almost $5000, Litton and colleagues reported.

“Higher ICU bed number and occupancy were each significantly associated with lower costs per patient bed-day; bed number did not influence annual cost per bed.

“The estimated total annual operational cost for ICU care in Australia was $2119 million, about 0.15% of gross domestic product and 1.4% of total health care costs. Staffing accounted for about 80% of ICU operational costs. Larger ICUs were associated with lower costs for medical staff but not for nursing staff.”

The authors concluded that: “As ICU costs declined with size and occupancy, increasing ICU size may have improved health care system efficiency.”

Potential vaccine treats and prevents deadly streptococcal toxic shock

A new vaccine developed by researchers from Griffith University Institute for Glycomics has the potential to treat and prevent toxic shock caused by invasive streptococcal disease, which kills more than 160 000 people every year. Streptococcus is the same bacteria group that causes common and non-life-threatening ailments such as school sores and tonsillitis, which are easily spread via coughing, sneezing and sharing food and drinks. In about one in 100 cases, the organism enters the body and becomes invasive streptococcal disease (ISD). ISD can be life-threatening, with mortality rates exceeding 25% in even the best-equipped facilities tasked with treating it. When ISD occurs, some strains can make more toxins than others and cause streptococcal toxic shock syndrome (STSS). The international research team, which includes scientists from Melbourne and Edmonton, Canada, used a transgenic (DNA altered genes) mouse model to develop a world-first STSS vaccine candidate – named “J8” – that showed a one-thousand- to one-million-fold reduction of the bacterial burden in the spleen and blood after infection. Antibodies developed from the streptococcal M protein and streptococcal pyrogenic exotoxin (SpeC) also cleared the infection in treated transgenic mice and ablated the mitogenic and inflammatory activity caused by the M protein. Now that antibodies have been generated, the next step would be to make monoclonal antibodies that could be suitable for a human trial study of J8’s efficacy against invasive streptococcal disease. The research was published in Science Advances.

Study confirms protective effect of diabetes drugs against kidney failure

A new meta-analysis published in Lancet Diabetes and Endocrinology has found that SGLT2 inhibitors can reduce the risk of dialysis, transplantation or death due to kidney disease in people with type 2 diabetes. Currently, more than 3 million people worldwide are estimated to be receiving treatment for kidney failure, and that number is predicted to increase to more than 5 million by 2035. SGLT2 inhibitors were developed to lower glucose levels for people with diabetes. Early studies showed they reduced levels of protein in the urine leading to great hopes they would protect against kidney failure. Since then, several large studies have been designed to examine whether SGLT2 inhibitors prevent heart attack, stroke and kidney disease. The researchers, from the George Institute for Global Health, conducted a meta-analysis, pooling data from major randomised controlled trials of SGLT2 inhibitors that reported effects on kidney outcomes in people with type 2 diabetes. Four studies involving almost 40 000 participants were included in the meta-analysis, which assessed three SGLT2 inhibitors – canagliflozin, empagliflozin and dapagliflozin – although most of the findings came from the CREDENCE study of canagliflozin. The results revealed: SGLT2 inhibitors reduced the risk of dialysis, transplantation, or death due to kidney disease by about 30%; SGLT2 inhibitors also reduced the risk of kidney failure by 30% and reduced the risk of acute kidney injury by 25%.

What’s new online at the MJA

Letter: Record number of influenza tests in 2019, not a “mutant flu crisis”
Sheppeard et al; doi: 10.5694/mja2.50321 … FREE ACCESS for 1 week

Podcast: Dr Vicky Sheppeard, Director of Communicable Diseases, NSW HealthOPEN ACCESS permanently

Perspective: Regulating voluntary assisted dying in Australia: some insights from the Netherlands
Onwuteaka-Philipsen et al; doi: 10.5694/mja2.50310
Over two decades of Dutch experience can inform deliberations about the nature of a regulatory framework in Australian jurisdictions … FREE ACCESS for 1 week

Research letter: The financial cost of intensive care in Australia: a multicentre registry study
Hicks et al; doi: 10.5694/mja2.50329
Increasing ICU size may have improved health care system efficiency … OPEN ACCESS permanently


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