A comparative cost analysis before and after opening of an intermediate care unit

Objective

To compare the hospital cost of intensive care patients before and after the opening of an intermediate care unit.

Design

A before–after prospective observational study.

Setting

University-affiliated mixed ICU, intermediate care unit (IMC) and standard wards.

Patients and participants

A total of 1539 ICU stays were admitted from January 2001 to December 2002; 786 ICU patients were included in the study by taken a random sample. During the period before opening the IMC 329 ICU patients were included, and 457 ICU patients after opening the IMC.

Interventions

Opening of a six-bed mixed IMC.

Measurements and results

For each ICU patient, the following cost data were collected: total hospital cost; divided into costs during ICU stay, IMC stay and general ward stay. The total hospital cost was computed from the first ICU admission to hospital discharge. The cost of readmissions to the ICU, IMC and wards during the same hospital stay were included. Comparisons concerning costs were performed after logarithmic transformation, to improve the symmetry of distributions. The mean total hospital cost before opening the IMC was €12.961 (± 14.530) and after opening the IMC was €16.513 (± 19.324) with a significant increase of €3552 (P value = 0.01) (Table 1).

Table 1

Statistical relations between individual hospital cost and patient characteristics were analysed (age, gender, mortality, surgical/ medical, kind of organ failure and nursing workload [TISS-28] of admission day). After correction of these variables, the increases of the hospital cost were explained by kind of organ failure (P = 0.08), surgical/medical (P = 0.26), and nursing workload (TISS-28) of admission day (P = 0.43).

Conclusion

This study showed an increase of total hospital cost after opening the IMC. A different patient population was admitted to the ICU after opening the IMC. More surgical patients, higher TISS score and the kind of organ failure varied between the populations before and after opening the IMC. The mean cost during the ICU stay per patient increased most (€3003).