A new method of accurately identifying costs of individual patients in intensive care: the initial results

Objectives: To analyse the patient-related and non-patient-related costs of intensive care using an activity-based costing methodology. Design: A retrospective cost analysis of 68 patients admitted sequentially over a 10-week period. Setting: The Adult General Intensive Care Unit of the Royal Hallamshire Hospital, Sheffield. Results: The results showed large variations in the costs obtained for individual patients. The calculation of the costs for the initial period of stay showed a wide variation depending on whether the costs were determined per calendar day or per first 24-h period. Significant correlations of costs between the first 24 h of stay and the admitting Acute Physiology and Chronic Health II score (p < 0.004) and daily costs with the Therapeutic Intervention Scoring System scores (p < 0.0001) were found. The average daily patient-related cost of care was $L 592. Overhead costs were calculated at $L 560 per patient day, which made the total cost of a day's treatment in intensive care $L 1152. Conclusions: The use of average costs or scoring systems to cost intensive care is limited, as these methods cannot determine actual resource usage in individual patients. The methodology described here allows all the resources used by an individual patient or group of patients to be identified and thus provides a valuable tool for economic evaluations of different treatment modalities.

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