Daily cost of an intensive care unit day: The contribution of mechanical ventilation*

Objective:To quantify the mean daily cost of intensive care, identify key factors associated with increased cost, and determine the incremental cost of mechanical ventilation during a day in the intensive care unit. Design:Retrospective cohort analysis using data from NDCHealth’s Hospital Patient Level Database. Setting:A total of 253 geographically diverse U.S. hospitals. Patients:The study included 51,009 patients ≥18 yrs of age admitted to an intensive care unit between October 1, 2002, and December 31, 2002. Interventions:None. Measurements and Main Results:Days of intensive care and mechanical ventilation were identified using billing data, and daily costs were calculated as the sum of daily charges multiplied by hospital-specific cost-to-charge ratios. Cost data are presented as mean (±sd). Incremental daily cost of mechanical ventilation was calculated using log-linear regression, adjusting for patient and hospital characteristics. Approximately 36% of identified patients were mechanically ventilated at some point during their intensive care unit stay. Mechanically ventilated patients were older (63.5 yrs vs. 61.7 yrs, p < .0001) and more likely to be male (56.1% vs. 51.8%, p < 0.0001), compared with patients who were not mechanically ventilated, and required mechanical ventilation for a mean duration of 5.6 days ± 9.6. Mean intensive care unit cost and length of stay were $31,574 ± 42,570 and 14.4 days ± 15.8 for patients requiring mechanical ventilation and $12,931 ± 20,569 and 8.5 days ± 10.5 for those not requiring mechanical ventilation. Daily costs were greatest on intensive care unit day 1 (mechanical ventilation, $10,794; no mechanical ventilation, $6,667), decreased on day 2 (mechanical ventilation:, $4,796; no mechanical ventilation, $3,496), and became stable after day 3 (mechanical ventilation, $3,968; no mechanical ventilation, $3,184). Adjusting for patient and hospital characteristics, the mean incremental cost of mechanical ventilation in intensive care unit patients was $1,522 per day (p < .001). Conclusions:Intensive care unit costs are highest during the first 2 days of admission, stabilizing at a lower level thereafter. Mechanical ventilation is associated with significantly higher daily costs for patients receiving treatment in the intensive care unit throughout their entire intensive care unit stay. Interventions that result in reduced intensive care unit length of stay and/or duration of mechanical ventilation could lead to substantial reductions in total inpatient cost.

[1]  T. Pendergraft,et al.  Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations. , 2004, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[2]  Victoria J. Fraser,et al.  Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center* , 2003, Critical care medicine.

[3]  S. Lemeshow,et al.  Length of Stay Data as a Guide to Hospital Economic Performance for ICU Patients , 2003, Medical care.

[4]  Mark Zezza,et al.  Health spending projections for 2002-2012. , 2003, Health affairs.

[5]  A. Shorr,et al.  An update on cost-effectiveness analysis in critical care , 2002, Current opinion in critical care.

[6]  E. Vamvakas,et al.  Allogeneic blood transfusion and postoperative duration of mechanical ventilation: effects of red cell supernatant, platelet supernatant, plasma components and total transfused fluid , 2002, Vox sanguinis.

[7]  Salvador Benito,et al.  Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. , 2002, JAMA.

[8]  P Jacobs,et al.  Descriptive patient data as an explanation for the variation in average daily costs in intensive care , 2001, Anaesthesia.

[9]  D. Cook,et al.  Do blood transfusions improve outcomes related to mechanical ventilation? , 2001, Chest.

[10]  C. Behrendt.  Acute respiratory failure in the United States: incidence and 31-day survival. , 2000, Chest.

[11]  Dollars and sense: a practical guide to cost analysis for hospital epidemiology and infection control. , 1999 .

[12]  Dollars and sense: a practical guide to cost analysis for hospital epidemiology and infection control. , 1999, Clinical performance and quality health care.

[13]  J. Vincent,et al.  The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. , 1995, JAMA.

[14]  M Gyldmark,et al.  A review of cost studies of intensive care units: problems with the cost concept. , 1995, Critical care medicine.

[15]  D W Young,et al.  The ratio of costs to charges: how good a basis for estimating costs? , 1995, Inquiry : a journal of medical care organization, provision and financing.

[16]  Cohen Il,et al.  Cost containment and mechanical ventilation in the United States. , 1994 .

[17]  C. Sirio,et al.  Cleveland Health Quality Choice (CHQC)--an ongoing collaborative, community-based outcomes assessment program. , 1994, New horizons.

[18]  I. L. Cohen,et al.  Economics of Mechanical Ventilation: Surviving the ʼ90s , 1994 .

[19]  I. L. Cohen,et al.  Cost containment and mechanical ventilation in the United States. , 1994, New horizons.

[20]  W. Knaus,et al.  The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. , 1991, Chest.

[21]  Utilization strategies for intensive care units. , 1989, JAMA.

[22]  Economics of mechanical ventilation. , 1988 .

[23]  N. Duan.  Smearing Estimate: A Nonparametric Retransformation Method , 1983 .