Abstract
BackgroundIntensive care units represent one of the largest clinical cost centers in hospitals. Mechanical ventilation accounts for a significant share of this cost. There is a relative dearth of information quantifying the impact of ventilation on daily ICU cost. We thus determine daily costs of ICU care, incremental cost of mechanical ventilation per ICU day, and further differentiate cost by underlying diseases.MethodsTotal ICU costs, length of ICU stay, and duration of mechanical ventilation of all 10,637 adult patients treated in ICUs at a German hospital in 2013 were analyzed for never-ventilated patients (N = 9181), patients ventilated at least 1 day, (N = 1455) and all patients (N = 10,637). Total ICU costs were regressed on the number of ICU days. Finally, costs were analyzed separately by ICD-10 chapter of main diagnosis.ResultsDaily non-ventilated costs were €999 (95%CI €924 - €1074), and ventilated costs were €1590 (95%CI €1524 - €1657), a 59% increase. Costs per non-ventilated ICU day differed substantially and were lowest for endocrine, nutritional or metabolic diseases (€844), and highest for musculoskeletal diseases (€1357). Costs per ventilated ICU day were lowest for diseases of the circulatory system (€1439) and highest for cancer patients (€1594). The relative cost increase due to ventilation was highest for diseases of the respiratory system (94%) and even non-systematic for patients with musculoskeletal diseases (13%, p = 0.634).ConclusionsResults show substantial variability of ICU costs for different underlying diseases and underline mechanical ventilation as an important driver of ICU costs.
Highlights
Intensive care units represent one of the largest clinical cost centers in hospitals
Despite the need for detailed cost data to inform policy makers, there is a relative dearth of information relating to the daily cost of Intensive care unit (ICU) care for different patient groups and the impact of Mechanical ventilation (MV) on these costs [2]
For the second and third group we regressed on the number of ventilation days. This way we estimate and compare the daily costs of ICU stay between the three groups in order to determine whether estimated costs of a single nonventilated ICU day are different between never-ventilated patients and patients that are ventilated at some point in their ICU stay
Summary
Intensive care units represent one of the largest clinical cost centers in hospitals. We determine daily costs of ICU care, incremental cost of mechanical ventilation per ICU day, and further differentiate cost by underlying diseases. Intensive care units (ICUs) represent one of the largest clinical cost centers in hospitals [1]. Despite the need for detailed cost data to inform policy makers, there is a relative dearth of information relating to the daily cost of ICU care for different patient groups and the impact of MV on these costs [2]. The objectives of this analysis is to determine the daily costs of ICU care, the incremental cost of MV per ICU day, and to further differentiate these cost figures for patients with different underlying diseases. This, we argue, is an important step towards a better understanding of resource utilization in hospitals and quantifying the burden of diseases requiring intensive care treatment
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