The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome.
Identifieur interne : 000048 ( Main/Exploration ); précédent : 000047; suivant : 000049The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome.
Auteurs : Cameron M. Baston [États-Unis] ; Norma B. Coe [États-Unis] ; Claude Guerin [France] ; Jordi Mancebo [Espagne] ; Scott Halpern [États-Unis]Source :
- Critical care medicine [ 1530-0293 ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Analyse coût-bénéfice (MeSH), Années de vie ajustées sur la qualité (MeSH), Arbres de décision (MeSH), Coûts hospitaliers (statistiques et données numériques), Décubitus ventral (MeSH), Humains (MeSH), Maladie aigüe (MeSH), Positionnement du patient (méthodes), Positionnement du patient (économie), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Syndrome de détresse respiratoire de l'adulte (thérapie), Syndrome de détresse respiratoire de l'adulte (économie), Unités de soins intensifs (statistiques et données numériques), Unités de soins intensifs (économie).
- MESH :
- méthodes : Positionnement du patient.
- statistiques et données numériques : Coûts hospitaliers, Unités de soins intensifs.
- thérapie : Syndrome de détresse respiratoire de l'adulte.
- économie : Positionnement du patient, Syndrome de détresse respiratoire de l'adulte, Unités de soins intensifs.
- Adulte d'âge moyen, Analyse coût-bénéfice, Années de vie ajustées sur la qualité, Arbres de décision, Décubitus ventral, Humains, Maladie aigüe, Sujet âgé, Sujet âgé de 80 ans ou plus.
English descriptors
- KwdEn :
- Acute Disease (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Cost-Benefit Analysis (MeSH), Decision Trees (MeSH), Hospital Costs (statistics & numerical data), Humans (MeSH), Intensive Care Units (economics), Intensive Care Units (statistics & numerical data), Middle Aged (MeSH), Patient Positioning (economics), Patient Positioning (methods), Prone Position (MeSH), Quality-Adjusted Life Years (MeSH), Respiratory Distress Syndrome, Adult (economics), Respiratory Distress Syndrome, Adult (therapy).
- MESH :
- economics : Intensive Care Units, Patient Positioning, Respiratory Distress Syndrome, Adult.
- methods : Patient Positioning.
- statistics & numerical data : Hospital Costs, Intensive Care Units.
- therapy : Respiratory Distress Syndrome, Adult.
- Acute Disease, Aged, Aged, 80 and over, Cost-Benefit Analysis, Decision Trees, Humans, Middle Aged, Prone Position, Quality-Adjusted Life Years.
Abstract
OBJECTIVES
Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome.
DESIGN
We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI.
SETTING
ICUs that care for patients with acute respiratory distress syndrome.
SUBJECTS
Patients with moderate to severe acute respiratory distress syndrome.
INTERVENTIONS
The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning.
MEASUREMENTS AND MAIN RESULTS
In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $31,156 (95% CI, -$158 to $92,179) (incremental cost-effectiveness ratio = $38,648 per quality-adjusted life year [95% CI, $1,695-$98,522]). If society was willing to pay $100,000 per quality-adjusted life year, any intervention costing less than $51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $5,242 (95% CI, -$19,035 to $41,019) (incremental cost-effectiveness ratio = $44,615 per extra survival [95% CI, -$250,912 to $558,222]). If hospitals were willing to pay $100,000 per survival-to-discharge, any intervention costing less than $5,140 per patient would represent good value.
CONCLUSIONS
Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.
DOI: 10.1097/CCM.0000000000003617
PubMed: 30779719
PubMed Central: PMC6383780
Affiliations:
- Espagne, France, États-Unis
- Catalogne, Massachusetts, Pennsylvanie, Île-de-France
- Barcelone, Créteil
Links toward previous steps (curation, corpus...)
Le document en format XML
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Baston</name><affiliation wicri:level="2"><nlm:affiliation>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia</wicri:cityArea></affiliation></author><author><name sortKey="Coe, Norma B" sort="Coe, Norma B" uniqKey="Coe N" first="Norma B" last="Coe">Norma B. 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Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>National Bureau of Economic Research, Cambridge, MA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>National Bureau of Economic Research, Cambridge</wicri:cityArea></affiliation></author><author><name sortKey="Guerin, Claude" sort="Guerin, Claude" uniqKey="Guerin C" first="Claude" last="Guerin">Claude Guerin</name><affiliation wicri:level="3"><nlm:affiliation>Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, INSERM 955, Créteil, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, INSERM 955, Créteil</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Créteil</settlement></placeName></affiliation></author><author><name sortKey="Mancebo, Jordi" sort="Mancebo, Jordi" uniqKey="Mancebo J" first="Jordi" last="Mancebo">Jordi Mancebo</name><affiliation wicri:level="3"><nlm:affiliation>Servicio de Medicina Intensiva Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Servicio de Medicina Intensiva Hospital de la Santa Creu i Sant Pau, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Halpern, Scott" sort="Halpern, Scott" uniqKey="Halpern S" first="Scott" last="Halpern">Scott Halpern</name><affiliation wicri:level="2"><nlm:affiliation>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:affiliation>Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia</wicri:cityArea></affiliation></author></analytic><series><title level="j">Critical care medicine</title><idno type="eISSN">1530-0293</idno><imprint><date when="2019" type="published">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Disease (MeSH)</term><term>Aged (MeSH)</term><term>Aged, 80 and over (MeSH)</term><term>Cost-Benefit Analysis (MeSH)</term><term>Decision Trees (MeSH)</term><term>Hospital Costs (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Intensive Care Units (economics)</term><term>Intensive Care Units (statistics & numerical data)</term><term>Middle Aged (MeSH)</term><term>Patient Positioning (economics)</term><term>Patient Positioning (methods)</term><term>Prone Position (MeSH)</term><term>Quality-Adjusted Life Years (MeSH)</term><term>Respiratory Distress Syndrome, Adult (economics)</term><term>Respiratory Distress Syndrome, Adult (therapy)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term><term>Analyse coût-bénéfice (MeSH)</term><term>Années de vie ajustées sur la qualité (MeSH)</term><term>Arbres de décision (MeSH)</term><term>Coûts hospitaliers (statistiques et données numériques)</term><term>Décubitus ventral (MeSH)</term><term>Humains (MeSH)</term><term>Maladie aigüe (MeSH)</term><term>Positionnement du patient (méthodes)</term><term>Positionnement du patient (économie)</term><term>Sujet âgé (MeSH)</term><term>Sujet âgé de 80 ans ou plus (MeSH)</term><term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term><term>Syndrome de détresse respiratoire de l'adulte (économie)</term><term>Unités de soins intensifs (statistiques et données numériques)</term><term>Unités de soins intensifs (économie)</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Intensive Care Units</term><term>Patient Positioning</term><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Patient Positioning</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Positionnement du patient</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Hospital Costs</term><term>Intensive Care Units</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Coûts hospitaliers</term><term>Unités de soins intensifs</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Respiratory Distress Syndrome, Adult</term></keywords><keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Syndrome de détresse respiratoire de l'adulte</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Positionnement du patient</term><term>Syndrome de détresse respiratoire de l'adulte</term><term>Unités de soins intensifs</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Acute Disease</term><term>Aged</term><term>Aged, 80 and over</term><term>Cost-Benefit Analysis</term><term>Decision Trees</term><term>Humans</term><term>Middle Aged</term><term>Prone Position</term><term>Quality-Adjusted Life Years</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Analyse coût-bénéfice</term><term>Années de vie ajustées sur la qualité</term><term>Arbres de décision</term><term>Décubitus ventral</term><term>Humains</term><term>Maladie aigüe</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI.</p></div><div type="abstract" xml:lang="en"><p><b>SETTING</b></p><p>ICUs that care for patients with acute respiratory distress syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>SUBJECTS</b></p><p>Patients with moderate to severe acute respiratory distress syndrome.</p></div><div type="abstract" xml:lang="en"><p><b>INTERVENTIONS</b></p><p>The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning.</p></div><div type="abstract" xml:lang="en"><p><b>MEASUREMENTS AND MAIN RESULTS</b></p><p>In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $31,156 (95% CI, -$158 to $92,179) (incremental cost-effectiveness ratio = $38,648 per quality-adjusted life year [95% CI, $1,695-$98,522]). If society was willing to pay $100,000 per quality-adjusted life year, any intervention costing less than $51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $5,242 (95% CI, -$19,035 to $41,019) (incremental cost-effectiveness ratio = $44,615 per extra survival [95% CI, -$250,912 to $558,222]). If hospitals were willing to pay $100,000 per survival-to-discharge, any intervention costing less than $5,140 per patient would represent good value.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">30779719</PMID><DateCompleted><Year>2020</Year><Month>01</Month><Day>02</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>09</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1530-0293</ISSN><JournalIssue CitedMedium="Internet"><Volume>47</Volume><Issue>3</Issue><PubDate><Year>2019</Year><Month>03</Month></PubDate></JournalIssue><Title>Critical care medicine</Title></Journal><ArticleTitle>The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome.</ArticleTitle><Pagination><MedlinePgn>e198-e205</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1097/CCM.0000000000003617</ELocationID><Abstract><AbstractText Label="OBJECTIVES">Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome.</AbstractText><AbstractText Label="DESIGN">We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI.</AbstractText><AbstractText Label="SETTING">ICUs that care for patients with acute respiratory distress syndrome.</AbstractText><AbstractText Label="SUBJECTS">Patients with moderate to severe acute respiratory distress syndrome.</AbstractText><AbstractText Label="INTERVENTIONS">The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning.</AbstractText><AbstractText Label="MEASUREMENTS AND MAIN RESULTS">In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $31,156 (95% CI, -$158 to $92,179) (incremental cost-effectiveness ratio = $38,648 per quality-adjusted life year [95% CI, $1,695-$98,522]). If society was willing to pay $100,000 per quality-adjusted life year, any intervention costing less than $51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $5,242 (95% CI, -$19,035 to $41,019) (incremental cost-effectiveness ratio = $44,615 per extra survival [95% CI, -$250,912 to $558,222]). If hospitals were willing to pay $100,000 per survival-to-discharge, any intervention costing less than $5,140 per patient would represent good value.</AbstractText><AbstractText Label="CONCLUSIONS">Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Baston</LastName><ForeName>Cameron M</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Coe</LastName><ForeName>Norma B</ForeName><Initials>NB</Initials><AffiliationInfo><Affiliation>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>National Bureau of Economic Research, Cambridge, MA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Guerin</LastName><ForeName>Claude</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, INSERM 955, Créteil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mancebo</LastName><ForeName>Jordi</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Servicio de Medicina Intensiva Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Halpern</LastName><ForeName>Scott</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>T32 HL007891</GrantID><Acronym>HL</Acronym><Agency>NHLBI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Crit Care Med</MedlineTA><NlmUniqueID>0355501</NlmUniqueID><ISSNLinking>0090-3493</ISSNLinking></MedlineJournalInfo><CitationSubset>AIM</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000208" MajorTopicYN="N">Acute Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003362" MajorTopicYN="N">Cost-Benefit Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003663" MajorTopicYN="N">Decision Trees</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017721" MajorTopicYN="N">Hospital Costs</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName><QualifierName UI="Q000191" MajorTopicYN="N">economics</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D056888" MajorTopicYN="N">Patient 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