University of Oulu

Raj, R., Bendel, S., Reinikainen, M., Hoppu, S., Laitio, R., Ala-Kokko, T., Curtze, S., Skrifvars, M. (2018) Costs, outcome and cost-effectiveness of neurocritical care: a multi-center observational study. Critical Care, 22, 225. doi:10.1186/s13054-018-2151-5

Costs, outcome and cost-effectiveness of neurocritical care : a multi-center observational study

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Author: Raj, R.1; Bendel, S.2; Reinikainen, M.3;
Organizations: 1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki
2Department of Intensive Care, Kuopio University Hospital & University of Eastern Finland
3Department of Intensive Care, North Karelia Central Hospital
4Department of Intensive Care, Tampere University Hospital & University of Tampere
5Department of Intensive Care, Turku University Hospital & University of Turku
6Department of Intensive Care, Oulu University Hospital & University of Oulu, Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care
7Department of Neurology, Helsinki University Hospital & University of Helsinki
8Department Anesthesia, Intensive Care and Pain Medicine and Department of Emergency Care and Services, Helsinki University Hospital & University of Helsinki
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2018-10-24


Background: Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU).

Methods: We used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003–2013. Outcome variables were one-year mortality and permanent disability. Total healthcare costs included the index university hospital costs, rehabilitation hospital costs and social security costs up to one year. All costs were converted to euros based on the 2013 currency rate.

Results: In total 7044 patients were included (44% with TBI, 13% with ICH, 27% with SAH, 16% with AIS). In comparison to TBI, ICH was associated with the highest risk of death and permanent disability (OR 2.6, 95% CI 2.1–3.2 and OR 1.7, 95% CI 1.4–2.1), followed by AIS (OR 1.9, 95% CI 1.5–2.3 and OR 1.5, 95% CI 1.3–1.8) and SAH (OR 1.8, 95% CI 1.5–2.1 and OR 0.8, 95% CI 0.6–0.9), after adjusting for severity of illness. SAH was associated with the highest mean total costs (€51,906) followed by ICH (€47,661), TBI (€43,916) and AIS (€39,222). Cost per independent survivor was lower for TBI (€58,497) and SAH (€96,369) compared to AIS (€104,374) and ICH (€178,071).

Conclusion: Neurocritical illnesses are costly and resource-demanding diseases associated with poor outcomes. Intensive care of patients with TBI or SAH more commonly result in independent survivors and is associated with lower total treatments costs compared to ICH and AIS.

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Series: Critical care
ISSN: 1364-8535
ISSN-E: 1875-7081
ISSN-L: 1364-8535
Volume: 22
Article number: 225
DOI: 10.1186/s13054-018-2151-5
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was funded with grants from Helsinki University (3-year project grant: H3702 73702705) and Helsinki University Hospital (state funding: VTR-TYH2014221). RR has received personal research grants from Svenska Kulturfonden, Medicinska Understödsföreningen Liv and Hälsa, Finska Läkaresällskapet, Maud Kuistilan Säätiö, Eemil Aaltosen Säätiö, Ella and Georg Ehrnroothin Säätiö, Suomalais-Norjalainen Lääketieteen Säätiö, Suomen Lääketieteen Säätiö, and Maire Taposen Säätiö.
Copyright information: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.