A German national prevalence study on the cost of ICU care: an evaluation from 51 ICUs

Background: Intensive Care Unit ( ICU) costs account for up to 20% of a hospitals costs. We aimed to analyse the individual patient related cost of intensive care at various hospital levels and different groups of disease. Methods: Data from 51 ICUs all over Germany ( 15 primary care ( pcH) and 14 general care ( gcH), 10 maximal care ( mcH) and 12 focused care hospitals ( fcH), were collected in a observational, cross-sectional one day point prevalence study by two external study physicians ( January-October 2003). All ICU patients ( length of stay ( LOS) >24 hours) treated on the study day were included. Reason for admission, severity of illness, surgical/diagnostic procedures, resource consumption, ICU/hospital LOS, outcome and ICU staffing structure were documented. Results: Altogether 453 patients were included. ICU ( hospital) mortality: 12.1% ( 15.7%). Reason for admission and the severity of illness differed between hospital level of care with a higher amount of unscheduled surgical procedures and patients needing mechanical ventilation in mcH and fcH facilities. Mean total costs per day were ()791 pound +/- 305 ( pcH ()685 pound +/- 234, gcH ()672 pound +/- 199, fcH ()816 pound +/- 363, mcH ()923 pound +/- 306) with the highest cost in septic patients ( ()1,090 pound +/- 422). Differences were associated with: staffing, amount of prescribed drugs/blood products and diagnostic procedures. Conclusions: Reason for admission, severity of illness and the occurrence of severe sepsis are directly related to the height 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.