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Cost comparisons and factors related to cost per stay in intensive care units in Belgium

BACKGROUND: Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the nati...

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Autores principales: Bruyneel, Arnaud, Larcin, Lionel, Martins, Dimitri, Van Den Bulcke, Julie, Leclercq, Pol, Pirson, Magali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10500739/
https://www.ncbi.nlm.nih.gov/pubmed/37705056
http://dx.doi.org/10.1186/s12913-023-09926-2
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author Bruyneel, Arnaud
Larcin, Lionel
Martins, Dimitri
Van Den Bulcke, Julie
Leclercq, Pol
Pirson, Magali
author_facet Bruyneel, Arnaud
Larcin, Lionel
Martins, Dimitri
Van Den Bulcke, Julie
Leclercq, Pol
Pirson, Magali
author_sort Bruyneel, Arnaud
collection PubMed
description BACKGROUND: Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium. METHODS: This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital’s point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor. RESULTS: The proportion of ICU beds to ward beds was a median [p25-p75] of 4.7% [4.4–5.9]. The proportion of indirect costs to total costs in the ICU was 12.1% [11.4–13.3]. The cost of nurses represented 57.2% [55.4–62.2] of direct costs and this was 15.9% [12.0-18.2] of the cost of nurses in the whole hospital. The median cost per stay was €4,267 [2,050–9,658] and was €2,160 [1,545–3,221] per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication. CONCLUSIONS: This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09926-2.
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spelling pubmed-105007392023-09-15 Cost comparisons and factors related to cost per stay in intensive care units in Belgium Bruyneel, Arnaud Larcin, Lionel Martins, Dimitri Van Den Bulcke, Julie Leclercq, Pol Pirson, Magali BMC Health Serv Res Research BACKGROUND: Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium. METHODS: This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital’s point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor. RESULTS: The proportion of ICU beds to ward beds was a median [p25-p75] of 4.7% [4.4–5.9]. The proportion of indirect costs to total costs in the ICU was 12.1% [11.4–13.3]. The cost of nurses represented 57.2% [55.4–62.2] of direct costs and this was 15.9% [12.0-18.2] of the cost of nurses in the whole hospital. The median cost per stay was €4,267 [2,050–9,658] and was €2,160 [1,545–3,221] per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication. CONCLUSIONS: This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09926-2. BioMed Central 2023-09-13 /pmc/articles/PMC10500739/ /pubmed/37705056 http://dx.doi.org/10.1186/s12913-023-09926-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bruyneel, Arnaud
Larcin, Lionel
Martins, Dimitri
Van Den Bulcke, Julie
Leclercq, Pol
Pirson, Magali
Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title_full Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title_fullStr Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title_full_unstemmed Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title_short Cost comparisons and factors related to cost per stay in intensive care units in Belgium
title_sort cost comparisons and factors related to cost per stay in intensive care units in belgium
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10500739/
https://www.ncbi.nlm.nih.gov/pubmed/37705056
http://dx.doi.org/10.1186/s12913-023-09926-2
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