We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Cost and Outcome of Intensive Care for Patients With AIDS, Pneumocystis carinii Pneumonia, and Severe Respiratory Failure

Robert M. Wachter, MD; John M. Luce, MD; Sharon Safrin, MD; Daniel C. Berrios, MD, MPH; Edwin Charlebois, MPH; Anne A. Scitovsky, MA
JAMA. 1995;273(3):230-235. doi:10.1001/jama.1995.03520270064033.
Text Size: A A A
Published online


Objective.  —To determine the costs and outcomes associated with intensive care unit (ICU) admission for patients with acquired immunodeficiency syndrome (AIDS)—related Pneumocystis carinii pneumonia (PCP), and severe respiratory failure.

Design.  —Survival and cost-effectiveness analysis.

Setting.  —A large municipal teaching hospital serving an indigent population.

Patients.  —Consecutive patients intubated and mechanically ventilated for AIDS, PCP, and respiratory failure from 1981 through 1991 (n=113). The cohort was separated into three groups for analysis: patients admitted to the ICU in 1981 through 1985 (era I, n=43), those admitted in 1986 through 1988 (era II, n=33), and those admitted in 1989 through 1991 (era III, n=37).

Main Outcome Measures.  —Hospital charges and survival time; cost per year of life saved, using a zero-cost, zero-life assumption.

Results.  —Twenty-eight (25%) of the 113 patients mechanically ventilated for PCP and respiratory failure survived to hospital discharge: six (14%) of 43 in era I,13 (39%) of 33 in era II, and nine (24%) of 37 in era III (P=.04). Post-ICU admission charges averaged $57 874 for the entire cohort, remaining relatively stable across the three eras. Cost of care for survivors was significantly more expensive than for those dying before discharge. The cost of ICU admission and subsequent hospitalization averaged $174 781 per year of life saved; $305 795 in era I, $94 528 in era II, and $215 233 in era III. Improved survival rates and shorter lengths of ICU stay led to the improved cost-effectiveness in era II, while the opposite trends resulted in worsening cost-effectiveness in recent years. The strongest predictors of hospital mortality in era III were low CD4 cell counts on hospital admission and the development of pneumothorax during mechanical ventilation.

Conclusions.  —The cost-effectiveness of intensive care for patients with PCP and severe respiratory failure improved during the first 8 years of the AIDS epidemic but fell in recent years such that it is now below that of many accepted medical interventions.(JAMA. 1995;273:230-235)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.