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Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19.

ABSTRACT: PURPOSE:The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). METHODS:We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The cross-sectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. RESULTS:We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI?=?35.3), followed by Estonia (AI?=?33.5) and Austria (AI?=?26.4), and lowest in Sweden (AI?=?5) and Denmark (AI?=?6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r?=?- 0.57; p?

SUBMITTER: Bauer J

PROVIDER: S-EPMC7472675 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19.

Bauer Jan J Brüggmann Dörthe D Klingelhöfer Doris D Maier Werner W Schwettmann Lars L Weiss Daniel J DJ Groneberg David A DA

Intensive care medicine 20200904 11

<h4>Purpose</h4>The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR).<h4>Methods</h4>We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita ( ...[more]

PMID: 32886208

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Project description:AimTo analyze access (availability, affordability and acceptability) to biologicals for Crohn's disease (CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development.MethodsA questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product (GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated.ResultsAt the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries (France, Germany, Latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, Poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden (13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary (87%-124%) and Romania (141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita (0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availability and affordability was also strong (-0.75, -0.69 respectively).ConclusionSubstantial inequalities in access to biologicals were largely associated with GDP. To explain differences in access among countries with similar development needs further research on acceptance.

Dataset Information

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19.

Publications

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19.

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