Skip to main content

Intensive insulin therapy-associated costs differ substantially between ICUs

Introduction

Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality of critically ill patients [1, 2]. A survey among ICU managers and nurse clinicians showed that <10% of participants evaluated costs surrounding the implementation of IIT [3]. We hypothesized IIT-associated costs to differ substantially between ICUs.

Methods

Three ICUs developed and implemented an evidence-based guideline for IIT. For 1 year before and 1 year after implementation, all disposables and devices explicitly used for IIT were identified in each hospital. Local costs were calculated, based on costs for disposables and devices. Variable cost included costs associated with disposables. Fixed cost included costs associated with syringe pumps and point-of-care devices for blood glucose level (BGL) measurements.

Results

A total of 2,490 patients were subjected to IIT. Patient demographics did not differ among the three ICUs and did not change over time. Median BGL declined from 119 (99 to 150) to 105 (85 to 130) mg/dl (P < 0.001). The number of BGL measurements per patient per day doubled from 4 (3 to 7) to 9 (5 to 12) per day (P < 0.001). Yearly variable costs increased from €58.574 to €118.624 (P < 0.001), yearly fixed costs increased from €450 to €14.282 (P < 0.001). Importantly, costs differed substantially from one centre to another: variable costs per patient increased from €34 (€13 to 75) to €116 (€61 to 212) (P < 0.001), from €13 (€5 to 44) to €48 (€32 to 88) (P < 0.001) and from €15 (€7 to 34) to €31 (€15 to 70) (P < 0.001) for the three ICUs, respectively. Fixed costs per bed per year increased from €0 to €250 (P < 0.001), from €13 to €384 (P < 0.001) and from €25 to €544 (P < 0.001) for the three ICUs, respectively.

Conclusions

Glucose control-associated costs rise with the implementation of IIT. Major differences in costs are noticed when comparing ICUs with similar patient cohorts and similar blood glucose control metrics after implementation of IIT.

References

  1. 1.

    Van den Berghe G, et al.: N Engl J Med. 2006, 354: 449-461.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Van den Berghe G, et al.: N Engl J Med. 2001, 345: 1359-1367.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Miller M, et al.: J Diabetes Sci Technol. 2007, 1: 903-906.

    PubMed Central  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to RE Harmsen.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Harmsen, R., Van Braam Houckgeest, F., Van der Sluijs, J. et al. Intensive insulin therapy-associated costs differ substantially between ICUs. Crit Care 15, P394 (2011). https://doi.org/10.1186/cc9814

Download citation

Keywords

  • Blood Glucose Level
  • Patient Demographic
  • Glucose Control
  • Yearly Variable
  • Syringe Pump