A review of cost studies of intensive care units: problems with the cost concept.

OBJECTIVE To study methods for costing hospital services, specifically in relation to multi-unit studies of activity, case mix, severity of illness, outcome, and resource use in adult intensive care units (ICUs). DATA SOURCES Twenty published cost studies of adult ICUs. The studies are all published in English and are both European and American. STUDY SELECTION Cost studies of adult ICUs published in international journals (English language). DATA EXTRACTION Literature survey, where the articles were obtained through MEDLINE and other database searches. DATA SYNTHESIS Cost of intensive care therapy was compared across the 20 studies. However, as stressed in the article, to compare costs of intensive care therapy across units is not possible for a number of reasons. One of the reasons for this limitation is that the studies employed different approaches to costing and thereby introduced a methodologic bias. In addition, the costing methodology applied in the majority of the studies was wrongly specified in relation to the purpose and viewpoint of the studies. CONCLUSIONS The methodologies for costing ICU therapy are flawed and fail to provide correct answers. In most studies, the study question is not adequately specified and the cost concept used in the studies is not tailored to the purposes of the study. Standardizing the cost model would lead to better, faster, and more reliable costing. This standardized cost model should not be rigid, but adaptable to different decision situations. A decision tree or taxonomy is proposed as a way toward better costing of ICU activity.

[1]  G W Torrance,et al.  Economic evaluation of neonatal intensive care of very-low-birth-weight infants. , 1983, The New England journal of medicine.

[2]  J. Thoner.  Outcome and costs of intensive care. A follow‐up study on patients requiring prolonged mechanical ventilation , 1987, Acta anaesthesiologica Scandinavica.

[3]  I. L. Cohen,et al.  Mechanical ventilation for the elderly patient in intensive care : incremental charges and benefits , 1993 .

[4]  J. Studnicki,et al.  Intensive care, survival, and expense of treating critically ill cancer patients. , 1993, JAMA.

[5]  A S Detsky,et al.  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit. , 1981, The New England journal of medicine.

[6]  S. Ridley,et al.  Cost of intensive therapy , 1991, Anaesthesia.

[7]  S. Lemeshow,et al.  Hospital charges and long‐term survival of ICU versus non‐ICU patients , 1982, Critical care medicine.

[8]  L. Wise,et al.  Diagnosis-related groups, costs, and outcome for patients in the intensive care unit. , 1989, Heart & lung : the journal of critical care.

[9]  D. Cullen,et al.  Results, charges, and benefits of intensive care for critically ill patients: Update 1983 , 1984, Critical care medicine.

[10]  B. Lind,et al.  Intensive care: cost and benefit , 1987, Acta anaesthesiologica Scandinavica. Supplementum.

[11]  K. Tolley,et al.  The treatment and care costs of people with HIV infection or AIDS: development of a standardised cost framework for Europe. , 1993, Health policy.

[12]  S. Ridley,et al.  A cost‐benefit analysis of intensive therapy , 1993, Anaesthesia.

[13]  E. Sivak,et al.  Impact of diagnosis-related groups' prospective payment on utilization of medical intensive care. , 1988, Chest.

[14]  S. Leeder,et al.  Costs, Severity of Illness and Outcome in Intensive Care , 1986, Anaesthesia and intensive care.

[15]  C J Coulton,et al.  Implications of DRG Payments for Medical Intensive Care , 1985, Medical care.