Analysis of costs in a pediatric ICU

Abstract

Objective: To analyze the actual cost of pediatric intensive care and its different components, particularly the differences between various patient groups, with special reference to the variable cost and the elements included in it. Design: Prospective, observational study. Setting: Multidisciplinary 12-bed pediatric intensive care unit (PICU) in a tertiary university hospital. Patients: 495 admissions to the unit over 17 consecutive months; 64.2 % were medical patients and 35.8 % were surgical patients; the mean (SE) stay in the PICU was 6.6 ± 0.4 days. Measurements and results: The fixed cost per day per patient was calculated, including the costs of physicians, nurses, auxiliary and other personnel who worked during the study period, and the costs of structural depreciation, maintenance, consumption, and disposable material. The variable cost was individually calculated from the costs of routine procedures and also included expenditure on pharmaceuticals, blood products, biochemical, hematological, and bacteriologic tests, radiology, image diagnosis procedures, and other procedures. The Physiologic Stability Index (PSI) was obtained in the first 24 h after admission. The mean fixed cost per patient per day was u. s. $ 608, which represents 72 % of the total patient cost during this study; 86 % of this amount was for personnel (58 % for nurses and auxiliary staff). Variable costs came to 28 % of the total amount, and were $ 218 ± 100 (M± SEM) per patient per day. In addition to the costs of their longer stay in the PICU, the daily variable costs of nonsurvivors were higher than those of survivors ($ 542 ± 52 vs $ 179 ± 7; p < 0.001). We classified the patients into four groups according to their PSI score in the first 24 h; variable daily costs increased (p < 0.05) in all comparisons with the PSI level: group I: < 4 points ($ 155 ± 0.5), group II: 5–9 points ($ 210 ± 13), group III: 10–14 points ($ 324 ± 54), group IV: > 15 points ($ 480 ± 42). However, this pattern was not found for all resources: the cost of treatment techniques and biochemical and hematological tests increased, but the consumption of antibiotics, parenteral nutrition, blood products, and bacteriologic tests reached their maximum level in groups I–III and radiology was not significantly influenced by PSI level. Conclusions: The cost of personnel was the biggest factor in intensive care costs: 62.4 % of the total costs. Nonsurvivors generated 3 times the mean variable daily expenditure on survivors and had longer stays in the PICU. The increase in PSI score on the first day was associated with a global increase in variable costs. The cost of treatment techniques significantly increased as the illness became more severe but consumption of antibiotics and parenteral nutrition and use of bacteriologic tests and radiology did not.