Cost-effectiveness comparison of risk groups: A case study involving acute respiratory distress syndrome (ARDS)

Objectives: This study explored the healthcare costs of various risk groups based on survival probability. Our findings can serve as a reference for healthcare policymakers and researchers.

Methods: Using a retrospective study of patient records, we identified variables to forecast the probability of survival in risk groups in an effort to analyze the resources required from the National Health Insurance (NHI) Administration to add one quality-adjusted life year (1QALY) to each group.

Results: Direct costs were shown to account for 0.087% of NHI expenditures on hospital care subsidies, and increased 10-fold when reimbursed by private health insurance. Indirect costs (median) were shown to account for GDP 12% per capita. Each additional high-, moderate, or low-risk patient cost the NHI Administration NTD 874,104, NTD 1,420,035 and NTD 3,488,272, respectively. Notably, the relative weights of diagnosis-related groups (DRGs) did not exhibit any differences in the level of resource consumption.

Conclusions: Important issues to consider in the consumption of medical resources and NHI spending on DRGs include the accuracy of diagnostic coding, the severity of illnesses, and co-morbidities. From an economic healthcare perspective, the sample groups in this study all met the evaluation criteria for cost-effectiveness recommended by the World Health Organization, and surpassed the economic threshold for cost-effectiveness. Our results can serve as a reference for future assessment of cost input and usage effectiveness.