Association between strained ICU capacity and healthcare costs in Canada: A population-based cohort study

Abstract

BackgroundIntensive care is resource intensive, with costs representing a substantial quantity of total hospitalization costs. Strained ICU capacity compromises care quality and adversely impacts outcomes; however, the association between strain and healthcare costs has not been explored. Materials and methodsPopulation-based cohort study performed in 17 adult ICUs in Alberta, Canada. Data were captured on hospitalizations, ambulatory care, physician services and drug dispenses occurring 1-year before and 1-year after index ICU admission. Strain was defined as occupancy ≥90%; with 21 additional definitions evaluated. Patients were categorized as strain and non-strain admissions. Costs attributable to strain, were calculated as difference-in-difference costs using propensity-score matching. Results30,557 patients were included (strain: 11,830 [38.7%]; non-strain: 18,727 [61.3%]). At 1-year, strain admissions had adjusted-incremental per-patient cost of CA$9406 (95%CI, $5654-13,157) compared to non-strain admissions, due to hospitalization costs (CA$7930; 95%CI, $4553-11,307) and physician claims (CA$844; 95%CI, $430–1259). This equated to CA$111.3 million (95%CI, $66.9–155.6 million) in excess attributable costs. Strain portended longer hospitalization (3.3 days; 95%CI, 1.1–5.5); and more ambulatory visits (1.0; 95%CI, 0.1–2.0) and physician claims (9.5; 95%CI, 6.2–12.7). Incremental costs were robust across strain definitions. ConclusionsAdmissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.