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Cost evaluation in adult ICU: α two-year study in a Greek State Hospital

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Dimitrios Kosmidis, Sotiria Koutsouki, Klairi Lampiri, Eva Ottilia Nagy, George Anastassopoulos, Vasilios Papaioannou, Ioannis Pnevmatikos
Dimitrios Kosmidis, Sotiria Koutsouki, Klairi Lampiri, Eva Ottilia Nagy, George Anastassopoulos, Vasilios Papaioannou, Ioannis Pnevmatikos


Background: During the last decades the combination of international economic and healthcare crisis has led to pressure on healthcare systems and has made financial evaluations particularly important.

Aim: To measure the total cost in ICUs, to analyze its components, and their changes during the study period.

Method and Material: All cost components in four cost categories (direct-variable, direct-fixed, indirect-variable, and indirect-fixed) of all patients admitted in a 6-bed mixed type adult ICU in a general (non-university) hospital of northern Greece in two consecutive periods, with total duration 2 years was measured. The direct-variable cost (medications, consumables, and diagnostic tests) was assessed with bottom-up (micro-costing) method while for the cost components of rest three categories the top-down (attributable costing) was used.

Results: In a 331 patients’ sample with 2823 total patient days, the sum cost was 2,417,788€ (1,370,420€ and 1,047,368€ in 1st and 2nd period respectively). The direct variable cost was 897,866.07€ (37.14%), the direct-fixed 1,049,068.6€ (43.39%), the indirect-variable 45,210.6€ (1.87%), and the indirect-fixed 425,643.0€ (17.60%). The mean daily cost per patient was 835.62€ and 885.35€, and the total cost per patient was 7,967.6€ and 6,587.2€ in the two periods of study respectively. The total cost of all non-survivors’ patients (N=85, 25.7%) was 595,009.1€ and the efficiency cost per survivor 9,828.4€. The mean daily cost and the total cost per survivor was 840.8€ and 7,409.7€ while for non-survivors was και 908.4€ and 7,000.1€ respectively. During the second study period, a reduction in total costs was observed and especially in direct-variable category attributed mainly to the prices of medicines consumables, and staff gradual costs reductions.

Conclusions: Changes in cost categories vary over time due to social and financial factors while the variables as the ICU environment or patient’s characteristics as severity of disease are the main cost drivers. Monitoring and recording of cost components variance would help with valuable information to healthcare managers, doctors, or nursing leaders. Extending this study with a multicenter to more ICUs could provide clearer conclusions about cost variability.


Cost evaluation; economic analysis; intensive care unit

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Penner S. Economics and financial management for nurses and nurse leaders. 3rd ed. New York, NY: Springer Publishing Company, LLC; 2017. ):638-43

Kerlin MP, Cooke CR. Understanding Costs When Seeking Value in Critical Care. Ann Am Thorac Soc. 2015; 12(12):1743-4.

The direction of health expenditure to health provider and to health care activities (HC x HP) - SHA 2011 EN (2009 - 2018) [Internet]. Hellenic Statistical Authority. 2015 [cited 1 November 2020]. Available from: https://www.statistics.gr/en/statistics/-/publication/SHE35/

Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: an epidemiologic study. Critical care medicine. 2004;32(3):638-43

Huynh TN, Kleerup EC, Wiley JF, Savitsky TD, Guse D, Garber BJ, et al. The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med. 2013;173(20):1887-94.

Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Critical care medicine. 2010;38(1):65-71.

Tan SS, Rutten FF, van Ineveld BM, et al. Comparing methodologies for the cost estimation of hospital ser-vices. Eur J Health Econ. 2009; 10:39-45.

Wordsworth S, Ludbrook A, Caskey F, Macleod A. Col-lecting unit cost data in multicentre studies: creating comparable methods. Eur J Health Econ. 2005; 6:38-44.

Andersen JS, Drenck NE, Keiding H. [Diagnosis Related Groups in intensive care units--cost model for critical-ly ill patients]. Ugeskr Laeger. 2007; 169(8):727-30.

Weiss M, Martin J, Feser U, Schafmayer C, Bauer M. Necessity and problems with case-related costing for intensive care patients. Der Anaesthesist. 2005; 54(3):254-62.

Rapoport J, Teres D, Zhao Y, Lemeshow S. Length of stay data as a guide to hospital economic performance for ICU patients. Medical care. 2003; 41(3):386-97.

Lefrant JY, Garrigues B, Pribil C, Bardoulat I, Courtial F, Maurel F, et al. The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units. An-aesthesia, critical care & pain medicine. 2015; 34(3):151-7.

Jegers M, Edbrooke DL, Hibbert CL, Chalfin DB, Bur-chardi H. Definitions and methods of cost assessment: an intensivist's guide. ESICM section on health re-search and outcome working group on cost effective-ness. Intensive care medicine. 2002; 28(6):680-5.

Graf J, Wagner J, Graf C, Koch KC, Janssens U. Five-year survival, quality of life, and individual costs of 303 consecutive medical intensive care patients--a cost-utility analysis. Critical care medicine. 2005; 33(3):547-55.

Smithies M, Bihari D, Chang R. Scoring systems and the measurement of ICU cost effectiveness. Réanima-tion urgencies. 1994;3:215–21

Kosmidis D., Koutsouki S., Lampiri K., Nagy EO, Papai-oannou V, Pneumatikos I, Anastassopoulos G. Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital. Comput Inform Nurs. 2017; 35(11), 582-589.

Tan SS, Bakker J, Hoogendoorn ME, Kapila A, Martin J, Pezzi A, et al. Direct cost analysis of intensive care unit stay in four European countries: applying a standard-ized costing methodology. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2012; 15(1):81-6.

Bloomfield E, Divertie GD, Burger CD, et al. A compari-son of intensive care unit physician staffing costs at the 3 Mayo Clinic sites. Mayo Clinic Proceedings. 2006; 81(11):1457-1461.

Moran JL, Peisach AR, Solomon PJ, Martin J Cost cal-culation and prediction in adult intensive care: a ground-up utilization study, Anaesthesia and Intensive Care. 2004; 32(6):787-797.

Rechner IJ, Lipman J. The costs of caring for patients in a tertiary referral Australian Intensive Care Unit. Anaes-thesia and Intensive Care. 2005; 33(4):477-482.

Ministry of Health and Social Solidarity. Report on the outcomes of Ministry of Health and its health units, 2011. Athens, Dionikos, March 2012 [in Greek]. In: Economou C, Kaitelidou D, Kentikelenis A, Sissouras A, Maresso A. The impact of the financial crisis on the health system and health in Greece. [Internet]. WHO 2014 [cited 14 May 2020]. Available from: https://www.euro.who.int/__data/assets/pdf_file/0007/266380/The-impact-of-the-financial-crisis-on-the-health-system-and-health-in-Greece.pdf?ua=1

Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266-71.

Vincent JL, Bihari DJ, Suter PM, et al: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in In-tensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995; 274: 639-644

Jia H, Li W, Hou T, Ma H, Yang Y, Wu A, et al. The At-tributable Direct Medical Cost of Healthcare Associat-ed Infection Caused by Multidrug Resistance Organ-isms in 68 Hospitals of China. Biomed Res Int. 2019; 2019:7634528.

Tansarli GS, Karageorgopoulos DE, Kapaskelis A, Fala-gas ME. Impact of antimicrobial multidrug resistance on inpatient care cost: an evaluation of the evidence. Expert Rev Anti Infect Ther. 2013; 11(3):321-31.

Adair JG. The Hawthorne effect: A reconsideration of the methodological artifact. Journal of Applied Psy-chology. 1984; 69(2):334-45.

Eurostat. Main GDP aggregates per capita [Internet]. Eurostat. [cited 8 June 2020]. Available from: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=nama_10_pc〈=en

Karabatsou D, Tsironi M, Tsigou E, Boutzouka E, Katsoulas T, Baltopoulos G. Variable cost of ICU care, a micro-costing analysis. Intensive Crit Care Nurs. 2016; 35:66-73.

Roberts RR, Frutos PW, Ciavarella GG, Gussow LM, Mensah EK, Kampe LM, Straus HE, Joseph G, Rydman RJ. Distribution of variable vs fixed costs of hospital care. JAMA 1999; 281:644–649.

Kerlin MP, Cooke CR. Understanding Costs When Seeking Value in Critical Care. Ann Am Thorac Soc. 2015; 12(12):1743-4.

Peter JV, Thomas K, Jeyaseelan L, Yadav B, Sudarsan TI, Christina J, et al. Cost of Intensive Care in India. Int J Technol Assess Health Care. 2016; 32(4):241-5.

Kulkarni AP, Divatia JV. A prospective audit of costs of intensive care in cancer patients in India. Indian J Crit Care Med. 2013; 17(5):292-7.

Khandelwal, N., Benkeser, D., Coe, N. B., Engelberg, R. A., Teno, J. M., & Curtis, J. R. Patterns of Cost for Pa-tients Dying in the Intensive Care Unit and Implications for Cost Savings of Palliative Care Interventions. Jour-nal of palliative medicine. 2016; 19(11):1171–1178. https://doi.org/10.1089/jpm.2016.0133

Kahn JM, Rubenfeld GD, Rohrbach J, Fuchs BD. Cost Savings Attributable to Reductions in Intensive Care Unit Length of Stay for Mechanically Ventilated Pa-tients. Medical Care. 2008; 46(12):1226-33.

Greece. Dept. of Health. 2015. Short-Term and Long-Term Control Measures of Prescribing and Execution Laboratories−Examinations. Government Gazette No. B 2816/2015:Annex E 21 Dec.


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