Abstract
Objective
To analyze the costs of treating critically ill patients.
Design and setting
Multicenter, observational, prospective, cohort, bottom-up study on variable costs in 51 ICUs.
Patients and participants
A total of 1,034 patients aged over 14 years who either spent less than 48 h in the ICU or had multiple trauma, major abdominal surgery, ischemic stroke, chronic obstructive pulmonary disease, cardiac failure, isolated head injury, acute lung injury/adult respiratory distress syndrome (ALI/ARDS), nontraumatic intracranial hemorrhage or coronary surgery.
Interventions
Data recorded for each patient: length of ICU stay, and cost in euros of all diagnostic and therapeutic procedures, drugs and equipment used, and consultations by physicians from other units. To express cost-efficiency we calculated for each diagnostic group the cost per surviving patient (expenditure for all patients/number of surviving patients) and money loss per patient (expenditure for patients who died/total number of patients).
Measurements and results
Median costs for a multiple trauma patient were €4076 and for coronary surgery patient €380. The variability is largely due to different lengths of ICU stay. Cost per surviving patient was higher for ALI/ARDS, nontraumatic intracranial hemorrhage, multiple trauma, and emergency abdominal surgery. Money loss per patient was higher for ALI/ARDS and lower for multiple trauma. Planned coronary and major abdominal surgery and short-stay patients were treated most cost-efficiently.
Conclusions
Cost of treatment in an ICU varies widely for different types of patients. Strategies are needed to contain the major determinants of high costs and low cost-efficiency.
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References
Guyatt G, Yalnizyan A, Devereaux PJ (2002) Solving the public health care sustainability puzzle. Can Med Assoc J 167:36–38
Heyland DK, Kernerman P, Gafni A, Cook DJ (1996) Economic evaluations in the critical care literature: do they help us improve the efficiency of our unit? Crit Care Med 24:1591–1598
Bloomfield E (2003) The impact of economics on changing medical technology with reference to critical care medicine in the United States. Anesth Analg 96:418–425
Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF (2003) Impact of intensive care unit (ICU) drug use on hospital costs: a descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Crit Care Med 31:S17–S24
Heyland DK, Gafni A, Kernerman P, Keenan S, Chalfin D (1999) How to use the results of an economic evaluation. Crit Care Med 27:1195–1202
Jegers M, Edbrooke DL, Hibbert CL, Chalfin DB, Burchardi H (2002) Definitions and methods of cost assessment: an intensivist's guide. ESICM section on health research and outcome working group on cost effectiveness. Intensive Care Med 28:680–685
Gyldmark M (1995) A review of cost studies of intensive care units: problems with the cost concept. Crit Care Med 23:964–972
Jacobs P, Edbrooke D, Hibbert C, Fassbender K, Corcoran M (2001) Descriptive patient data as an explanation for the variation in average daily costs in intensive care. Anaesthesia 56:643–647
Brazzi L, Bertolini G, Arrighi E, Rossi F, Facchini R, Luciani D (2002) Top-down costing: problems in determining staff costs in intensive care medicine. Intensive Care Med 28:1661–1663
Bertolini G, Rossi C, Brazzi L, Radrizzani D, Rossi G, Arrighi E, Simini B (2003) The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study. Intensive Care Med 29:2307–2311
Reis Miranda D, Moreno R, Iapichino G (1997) Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 23:760–765
Bertolini G, D'Amico R, Apolone G, Cattaneo A, Ravizza A, Iapichino G, Brazzi L, Melotti RM (1998) Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1:393 patients. GiViTi Investigators (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva). Simplified Acute Physiology Score. Med Care 36:1371–1382
Rothman KJ, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott, Philadelphia
Kleinbaum D, Kupper L, Muller K (1988) Applied regression analysis and other multivariable methods. PWS-KENT, Boston
Edbrooke DL, Ridley SA, Hibbert CL, Corcoran M (2001) Variations in expenditure between adult general intensive care units in the UK. Anaesthesia 56:208–216
Drummond M, O'Brien B, Stoddart G, et al (1997) Methods for the economic evaluation of health care programmes, 2nd edn. Oxford University Press, New York
Sznajder M, Aegerter P, Launois R, Merliere Y, Guidet B, CubRea (2001) A cost-effectiveness analysis of stays in intensive care units. Intensive Care Med 27:146–153
Luce JM, Rubenfeld GD (2002) Can health care costs be reduced by limiting intensive care at the end of life? Am J Respir Crit Care Med 165:750–754
Stevens VG, Hibbert CL, Edbrooke DL (1998) Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit. Anaesthesia 53:944–950
Edbrooke DL, Stevens VG, Hibbert CL, Mann AJ, Wilson AJ (1997) A new method of accurately identifying costs of individual patients in intensive care: the initial results. Intensive Care Med 23:645–650
Ridley S, Biggam M, Stone P (1994) A cost-utility analysis of intensive therapy. II: Quality of life in survivors. Anaesthesia 49:192–196
Vincent JL (1997) Dear SIRS, I'm sorry to say that I don't like you. Crit Care Med 25:372–374
Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, Schneider H, Burchardi H (2002) Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 28:1440–1446
Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348:138–150
Raikou M, Briggs A, Gray A, McGuire A (2000) Centre-specific or average unit costs in multi-centre studies? Some theory and simulation. Health Econ 9:191–198
Conti G, Dell'Utri D, Pelaia P, Rosa G, Cogliati AA, Gasparetto A (1998) Do we know the costs of what we prescribe? A study on awareness of the cost of drugs and devices among ICU staff. Intensive Care Med 24:1194–1198
Acknowledgements
The complete list of participants in the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva is as follows: Barberis Bruno, Rivoli; Biancofiore Gianni, Pisa; Carnevale Livio, Pavia; Cesaro Paolo, Giugliano in Campania; Ciceri Gabriella, Desio; Ciceri Rita, Lecco; Cirillo Francesco Maria, Legnago; Del Sarto Paolo, Massa; Digito Antonio, Vicenza; Doldo Giuseppe, Reggio Calabria; Franco Gabriele, Castellana Grotte; Fulgenzi Giuliano, Pesaro; Garelli Alberto, Ravenna; Giannoni Stefano, Empoli; Gorietti Adonella, Perugia; Guadagnucci Alberto, Massa; Lagomarsini Ginetta, Pisa; Lavacchi Luca, Pistoia; Maitan Stefano, Faenza; Malacarne Paolo, Pisa; Mancinelli Annetta, Chieti; Mantovani Giorgio, Ferrara; Marafon Silvio, Vicenza; Marcora Barbara, Monza; Melis Piergiorgio, Lucca; Muttini Stefano, Vimercate; Negri Giovanni, Pavia; Neri Massimo, Bologna; Paternesi Nazareno, Macerata; Pecunia Laura, Genova; Pennacchioni Silvio, Ancona; Pergolo Augusto, Genua; Pessina Carla, Rho; Postiglione Maurizio, Naples; Quattrocchi Pasqualino, Catania; Radrizzani Danilo, Legnago; Rossi Giancarlo, Livorno; Rotelli Stefano, Milano; Salvi Giovanni, Imperia; Segala Vincenzo, Torino; Siviero Silvano, Rovigo; Solinas Giommaria, Lanusei; Spadini Elisabetta, Parma; Tavola Mario, Lecco; Terragni Pierpaolo, Torino; Todesco Livio, Cittadella; Trivella Patrizia, Bergamo; Visconti Maria Grazia, Cernusco sul Naviglio; Zanforlin Giancarlo, Milano; Zappa Sergio, Brescia. We are indebted to J.D. Baggott for revision of the manuscript.
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For the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. GiViTI is the recipient of educational grants from: AstraZeneca Italy, Sanofi-Aventis Italy, and Draeger Italia. A complete list of study participants is presented under Acknowledgements.
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Rossi, C., Simini, B., Brazzi, L. et al. Variable costs of ICU patients: a multicenter prospective study. Intensive Care Med 32, 545–552 (2006). https://doi.org/10.1007/s00134-006-0080-2
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DOI: https://doi.org/10.1007/s00134-006-0080-2