The costs of intensive care

Introduction

For most countries, there are no good estimates for the costs of intensive care (IC) although it is known that the ICU is a major inpatient cost driver. The aim of this study was to estimate the real costs of IC in two hospitals in The Netherlands using a micro-costing methodology.

Methods

The costing study was undertaken at two hospitals in The Netherlands. We conducted a retrospective cost analysis of 200 consecutive patients admitted to a 32-bed mixed adult ICU at an academic hospital during two periods in 2006: 16 April–15 May and 5 June–23 June. For comparison, we collected detailed data at a general hospital that has a 10 bed-adult general ICU for the period 1 January–1 July 2003. The costs were adjusted to 2005 using the general price index. Both times, we applied a micro-costing approach, implying that all relevant resources were identified and valued at a detailed level.

Data on resource use of diagnostics, drugs, fluids, materials, admission and discharge were acquired from the computerized Patient Data Management System in both hospitals. Hotel and nutrition costs were collected from the respective financial departments. These costs were divided by the annual number of patient-days to calculate the cost per day. The NEMS or TISS scores in the academic or general hospital, respectively, were used to estimate nursing time per patient per day. The costs of medical specialists were based on the labour costs and the number of ICU days per year. In the academic hospital, time for consultations of medical staff attributable to each individual patient-day was prospectively collected using patient record forms. These costs we assumed to be comparable in the general hospital in the absence of detailed data.

Unit costs of diagnostics and consumables were derived from the financial hospital databases. Labour costs were based on standardised costs per minute, which equalled the normative income divided by the number of workable minutes per year. Estimates of the costs of inpatient-days and nonpatient-related care were based on the annual account for 2005 of the hospitals. Nonpatient-related care (capital, overhead) was appointed to patients using a marginal mark-up percentage.

Results

In the academic hospital the average total costs per ICU day amounted to €1,775, compared with €1,703 in the general hospital. The distribution of the costs by cost component varied.

Conclusion

The overall costs per day for IC in an academic hospital were slightly higher than the costs for an ICU day in a general hospital. These derived costs fit nicely to the official reference costs of €1,730 for an ICU day in The Netherlands, which is based on a global top-down approach.