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The Impact of Mortality on Total Costs Within the ICU

Kramer, Andrew A. PhD1; Dasta, Joseph F. MSc, MCCM, FCCP2,3; Kane-Gill, Sandra L. PharmD, MS, FCCM4

doi: 10.1097/CCM.0000000000002563
Clinical Investigations

Objectives: The high cost of critical care has engendered research into identifying influential factors. However, existing studies have not considered patient vital status at ICU discharge. This study sought to determine the effect of mortality upon the total cost of an ICU stay.

Design: Retrospective cohort study.

Setting: Twenty-six ICUs at 13 hospitals in the United States.

Patients: 58,344 admissions from January 1, 2012, to June 30, 2016, obtained from a commercial ICU database.

Interventions: None.

Measurements and Main Results: The median observed cost of a unit stay was $9,619 (mean = $16,353). A multivariable regression model was developed on the log of total costs for a unit stay, using severity of illness, unit admitting diagnosis, mortality in the unit, daily unit occupancy (occupying a bed at midnight), and length of mechanical ventilation. This model had an r2 of 0.67 and a median difference between observed and expected costs of $437. The first few days of care and the first day receiving mechanical ventilation had the largest effect on total costs. Patients dying before unit discharge had 12.4% greater costs than survivors (p < 0.01; 99% CI = 9.3–15.5%) after multivariable adjustment. This effect was most pronounced for patients with an extended ICU stay who were receiving mechanical ventilation.

Conclusions: While the largest drivers of ICU costs at the patient level are day 1 room occupancy and day 1 mechanical ventilation, mortality before unit discharge is associated with substantially higher costs. The increase was most evident for patients with an extended ICU stay who were receiving mechanical ventilation. Studies evaluating costs among ICUs need to take mortality into account.

1Prescient Healthcare Consulting, Charlottesville, VA.

2Division of Pharmacy Practice and Science, The Ohio State University, Columbus, OH.

3Division of Health Outcomes & Pharmacy Practice, The University of Texas, Austin, TX.

4Critical Care Medicine, Biomedical Informatics and Clinical Translational Sciences, University of Pittsburgh, Pittsburgh, PA.

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Dr. Dasta received funding from consulting for AcelRx, AbbVie, Bayer Pharma AG, Cumberland Pharmaceuticals, Hospira, Janssen Scientific Affairs, LLC Medtronic, Otsuka America Pharmaceuticals, Phillips-VISICU, The Medicines Company, and Pacira. He received funding from owning stock in Merck, Pfizer, Abbvie, Abbott Labs, Bristol Myers Squibb, Eli Lilly, and Express Scripts. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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