Figures on life expectancy in the general population were obtained from EUROSTAT [19] for European countries, and from the U.S Census Bureau – International Data Base [20] for Israel.Sensitivity http://www.selleckchem.com/products/Sorafenib-Tosylate.html analysesA number of sensitivity analyses have been performed to assess the robustness of the results of our study, where we varied; 1) inclusion of individual centres in the analysis (excluding the two centres with the most extreme results for effectiveness); 2) inclusion of patients in the analysis, according to the reason for ICU triage (ICU treatment/observation); 3) method used to estimate ICU daily costs.Excluding centres with extreme resultsAlthough in the main cost-effectiveness analyses we accounted for the variability across centres by use of multilevel models for effectiveness and cost estimates, it is possible that the overall results might have been driven by one or two centres with extreme results.

In order to evaluate the robustness of our findings, we performed a sensitivity analyses where we excluded the two centres with the most extreme results, one suggesting a very large benefit of ICU admission (odds ratio of 0.3; 95% CI: 0.1 to 0.4) and one suggesting harm (1.2; 95% CI: 0.8 to 1.8), compared with the others.Excluding problematic categories of patientsAlthough we adjusted the analyses for potential confounding factors and for study centre, still the presence of some categories of patients in our study population could have biased the results. Such patients include those referred to ICU only for observation and those admitted to ICU even if affected by terminal cancer.

In both situations, the policy for ICU admission varies widely across centres, heavily depending on the availability of high dependency units or intermediate care units in the same hospital, as well as on cultural or religious factors. Therefore, we performed sensitivity analyses where we excluded: Drug_discovery 1) patients referred to ICU for observation, thus only considering patients who had been triaged for ICU treatment; 2) patients with terminal cancer. Because direct information on the presence of terminal cancer was not available, we used a diagnosis of cancer accompanied with a Karnofsky score ��50 (50 = “requires considerable assistance and frequent medical care”) as a proxy for terminal cancer.Estimating ICU daily cost based on level of careIn the ICU, unlike the ward, patients receive very different levels of nursing care. Nurses represent the largest cost component in ICU, so that different levels of nursing care translate into a high variability of daily cost per patient [1].