Last Monday we were captivated by the excellent presentation from Dr Paul Young. Paul was able to deliver, what was quite a technical subject, Intensive Care Research, in an ‘easy to understand’ format. Paul shared how he had completed a BSc (Hons) at Victoria University of Wellington, before studying medicine at the University of Auckland. Paul completed most of his Intensive Care Specialist training in Melbourne, before returning to Wellington where he has worked as an Intensive Care Specialist since 2010. In 2016 he also completed a PhD in clinical research.
Paul is a leading member of the international care research community, including:
- Medical Director of Wakefield Hospital ICU
- Head of the Intensive Care Research Unit at Wellington Hospital
- An active member of the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Deputy Director, Intensive Care Medicine Programme Unit
- Adjunct Professor at the Australian & New Zealand Intensive Care Research Centre, Monash University, Melbourne
- Clinical Associate Professor in Critical Care, University of Melbourne
- Associate Editor for Critical Care and Resuscitation, the highest impact journal in the field of Intensive Care Medicine outside the US and Europe
- Has published nearly 300 peer-reviewed journal articles, including numerous high impact publications in the New England Journal of Medicine, the Lancet, and the Journal of the American Medical Association.
- Fellow of the College of Intensive Care Medicine of Australia and New Zealand.
- Awarded the Health Research Council's Liley Medal, recognising an outstanding contribution to health research
Paul kindly sent this summary showing some returns on NZ intensive care research investment. Most of these are studies that he talked about but there are few different ones that he did not talk about included here too (which is why the return for each dollar invested is a different number than in the talk).
RETURN ON INVESTMENT IN NEW ZEALAND INTENSIVE CARE RESEARCH
The Health Research Council of New Zealand has invested a total of $16M in intensive care research that has been completed in the past 15 years. The impact of this research includes:
70 fewer critically ill adults die and 49 fewer require acute kidney dialysis each year in New Zealand following implementation of our intravenous crystalloid fluid research; the direct cost savings of avoiding such dialysis episodes is $60,000 saved per year.
360 fewer adults develop acute kidney injury and 290 fewer patients develop surgical site infection after major surgery as a result of implementation of liberal fluid therapy each year in New Zealand; cost savings to the healthcare system from avoiding these surgical site infections are $6M saved per year in New Zealand
35 fewer heart surgery patients have a heart attack, stroke, kidney failure or die each year in New Zealand as a result of implementation of our research on restrictive transfusion; the direct healthcare savings from blood products alone is $2M saved per year in New Zealand.
20 fewer patients die per year in New Zealand following major trauma as a result of implementation of pre-hospital tranexamic acid therapy to prevent exsanguination in major trauma; this therapy costs $5.95 per patient.
221 fewer patients require kidney dialysis in ICU each year as result of research demonstrating that intravenous starch solutions are toxic to the kidneys. The cost saving to the New Zealand health system from this research is $2.5M saved per year. Starch solutions were removed from sale in New Zealand as a result of advice provided to Medsafe following this research.
46 lives saved each year in New Zealand by not using vitamin C to treat septic shock at a saving of $1.2M each year (direct cost savings from not paying for vitamin C)
$3.25M saved per year in New Zealand by de-implementation of therapeutic hypothermia in post cardiac arrest patients after research showed that this therapy increased ICU support requirements and did not improve patient outcomes
27 fewer patients each year in New Zealand end up on permanent dialysis as a result of implementation of delayed initiation of dialysis in acute kidney injury. The direct cost savings to the New Zealand healthcare system of these patients avoiding dialysis are $3.34M saved per year.
$14.5M saved in ICU costs per year in New Zealand as a result of the use of hydrocortisone to hasten recovery and decrease ICU support requirements in patients with septic shock.
$20M saved per year in healthcare costs associated with implementing the findings of the DECRA trial and not performing early decompressive craniectomy for diffuse severe brain injury (the DECRA trial showed that decompressive craniectomy did not affect mortality rates in severe brain trauma but increased the number of highly dependent survivors, each of which had estimated lifetime care costs of $1M).
Establishing the effectiveness of a range of therapies for COVID-19 and likely saving over a million lives around the world during the pandemic.
The ongoing savings to the NZ health system from this research are $51.59M p.a.
Every $1 invested returns $48 in direct savings per year (and continues to generate these savings on an ongoing basis without further investment).