The inverse relationship between cost and survival in the critically ill cancer patient

Crit Care Med. 1979 Jan;7(1):20-3. doi: 10.1097/00003246-197901000-00005.


The enormous cost of intensive multiple organ system support is apparent from patient or third party charges of $1500--$2000 per day exclusive of physician fees sampled during a retrospective review of 700 consecutive recent admissions to the Critical Care Facility of Memorial Cancer Center. Mortality rates of 49% for general medical, 54% for lymphoma or leukemia, and 20% for surgery patients suggest the need for a selective admission and discharge policy which concentrates financial and personnel resources on those for whom there remains a reasonable chance of worthwhile palliation, if not cure, of their malignancy. An informal policy of this kind may have contributed to a 10% increase in hospital discharges and a reduction of in-unit mortality from 22--18% when compared to 1035 earlier unselected admissions. A modified version of the classification suggested by the Critical Care Committee of the Massachusetts General Hospital has been adopted for use at this institution. A similar approach by other cancer centers is urged so that predictive indices based on prognosis of the underlying disease as well as physiological status may be developed. Otherwise, cost-benefit analysis by third party payers or government will become an unavoidable, and less satisfactory, alternative.

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Costs and Cost Analysis*
  • Critical Care / economics*
  • Fees, Medical
  • Financing, Government
  • Health Expenditures
  • Hospitalization
  • Humans
  • Insurance, Health
  • Length of Stay
  • Massachusetts
  • Middle Aged
  • Monitoring, Physiologic
  • Neoplasms / mortality
  • Neoplasms / therapy*
  • Prognosis
  • Retrospective Studies
  • Terminal Care