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Determining the economic cost of ICU treatment: a prospective “micro-costing” study

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Abstract

Objective

To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of “severity of illness” scores in estimating ICU cost.

Methods and design

A prospective study costing 64 consecutive admissions over a 2-month period in a mixed medical/surgical ICU.

Results

The median daily ICU cost (interquartile range, IQR) was €2,205 (€1,932–€3,073), and the median total ICU cost (IQR) was €10,916 (€4,294–€24,091). ICU survivors had a lower median daily ICU cost at €2,164 per day, compared with €3,496 per day for ICU non-survivors (P = 0.08). The requirements for continuous haemodiafiltration, blood products and anti-fungal agents were associated with higher daily and overall ICU costs (P = 0.002). Each point increase in SAPS3 was associated with a €305 (95% CI €31–€579) increase in total ICU cost (P = 0.029). However, SAPS3 accounted for a small proportion of the variance in this model (R 2 = 0.08), limiting its usefulness as a stand-alone predictor of cost in clinical practice. A model including haemodiafiltration, blood products and anti-fungal agents explained 54% of the variance in total ICU cost.

Conclusion

This bottom-up costing study highlighted the considerable individual variation in costs between ICU patients and identified the major factors contributing to cost. As the requirement for expensive interventions was the main driver for ICU cost, “severity of illness” scores may not be useful as stand-alone predictors of cost in the ICU.

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Abbreviations

APACHE II:

Acute Physiology and Chronic Health Evaluation Score II

CI:

Confidence interval

CT:

Computed tomography scan

CXR:

Chest X-ray

FFP:

Fresh frozen plasma

ICU:

Intensive care unit

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

NICE:

National Institute for Clinical Excellence

NIV:

Non-invasive ventilation

SAPS 3:

Simplified Acute Physiology Score 3

SD:

Standard deviation

SOFA:

Sequential Organ Failure Assessment Score

U/S:

Ultrasound scan

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Acknowledgments

The authors would like to thank Dr. J. Boylan for his valuable advice in preparing this manuscript. The authors acknowledge financial support from Dr. Canavan from the UK Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust.

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Authors and Affiliations

  1. Department of Intensive Care, Adelaide and Meath Hospital, The National Children’s Hospital, Tallaght, Dublin 24, Ireland

    Anne Marie McLaughlin, Judy Hardt & Maria B. Donnelly

  2. NIHR comprehensive Biomedical Research Centre, Guy’s & St Thomas’ Hospitals, London and King’s College London, London, UK

    James B. Canavan

Authors
  1. Anne Marie McLaughlin
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  2. Judy Hardt
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  3. James B. Canavan
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  4. Maria B. Donnelly
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Corresponding author

Correspondence to Anne Marie McLaughlin.

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McLaughlin, A.M., Hardt, J., Canavan, J.B. et al. Determining the economic cost of ICU treatment: a prospective “micro-costing” study. Intensive Care Med 35, 2135–2140 (2009). https://doi.org/10.1007/s00134-009-1622-1

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  • DOI: https://doi.org/10.1007/s00134-009-1622-1

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