Research

A German national prevalence study on the cost of intensive care: an evaluation from 51 intensive care units

Onnen Moerer¹ , Enno Plock¹ , Uchenna Mgbor¹ , Alexandra Schmid² , Heinz Schneider² , Manfred Bernd Wischnewsky³ and Hilmar Burchardi¹

¹Department of Anaesthesiology, Emergency and Critical Care Medicine, University of Göttingen, Robert-Koch-Straße 40, Göttingen 37075, Germany

²HealthEcon Ltd, Steinentorstraße 19, Basel 4051, Switzerland

³Faculty of Mathematics and Computer Science, University of Bremen, Bibliothekstraße 1, Bremen 28359, Germany

author email corresponding author email

Critical Care 2007, 11:R69doi:10.1186/cc5952

Published:	26 June 2007

Abstract

Introduction

Intensive care unit (ICU) costs account for up to 20% of a hospital's costs. We aimed to analyse the individual patient-related cost of intensive care at various hospital levels and for different groups of disease.

Methods

Data from 51 ICUs all over Germany (15 primary care hospitals and 14 general care hospitals, 10 maximal care hospitals and 12 focused care hospitals) were collected in an observational, cross-sectional, one-day point prevalence study by two external study physicians (January–October 2003). All ICU patients (length of stay > 24 hours) treated on the study day were included. The reason for admission, severity of illness, surgical/diagnostic procedures, resource consumption, ICU/hospital length of stay, outcome and ICU staffing structure were documented.

Results

Altogether 453 patients were included. ICU (hospital) mortality was 12.1% (15.7%). The reason for admission and the severity of illness differed between the hospital levels of care, with a higher amount of unscheduled surgical procedures and patients needing mechanical ventilation in maximal care hospital and focused care hospital facilities. The mean total costs per day were €791 ± 305 (primary care hospitals, €685 ± 234; general care hospitals, €672 ± 199; focused care hospitals, €816 ± 363; maximal care hospitals, €923 ± 306), with the highest cost in septic patients (€1,090 ± 422). Differences were associated with staffing, the amount of prescribed drugs/blood products and diagnostic procedures.

Conclusion

The reason for admission, the severity of illness and the occurrence of severe sepsis are directly related to the level of ICU cost. A high fraction of costs result from staffing (up to 62%). Specialized and maximum care hospitals treat a higher proportion of the more severely ill and most expensive patients.