Intensive care expenditure on overdose admissions

Introduction

In Scotland, 3% of intensive care admissions relate to drug overdoses. In Greater Glasgow, €12 million are annually spent on drug misuse services. UK studies have related a therapeutic intervention scoring system (TISS) to expenditure [1]. We investigated the costs of overdose admissions in a teaching hospital intensive care unit (ICU) from 1 January 1997 to 31 December 2000.

Method

Data were collected prospectively for all overdose admissions to the intensive care unit using Ward Watcher software (Critical Care Audit Ltd, Yorkshire, UK).

Result

A total of 3.8% (n = 70) of all ICU admissions (n = 1846) were due to overdoses. During the same period, the Accident & Emergency Department admitted 4097 patients with the same diagnosis. Comparing overdose patients with the whole ICU population, the mean age was 36.6 years versus 56.5 years; mean stay was 1 day (median 0.8) versus 4.02 days (median 1.8); TISS score was 41.8 ± 30.3 versus 144.7 ± 171.7; and available APACHE scores were 15 ± 6.5 versus 18.84 ± 7.48. Overdose mortality was 3%. Overall ICU mortality was 23%.

Over the 4 years, the whole ICU population accumulated a TISS score of 266,360. On a basis of €25–31 per TISS point, this relates to an expenditure of €6.7–8.3 million. The overdose group collected a score of 2926, giving an overall cost of €0.07–0.09 million.

Conclusion

Drug overdoses accounted for 3.8% of ICU admissions but only for 1.1% of the overall treatment costs. Only 1.7% of overdose hospital admissions required ICU admission. Nevertheless, drug overdose admissions are a significant component of the workload and costs of our ICU.

Table 1