Return on investment of rapid ICU workforce upskilling: an economic and cost-effectiveness analysis

Intensive Care Medicine: Volume 51, pages 1453–1461, Published: 21 July 2025

Abstract

Purpose

Although healthcare crises are infrequent, they may place extraordinary stress on Intensive Care Units (ICUs), often exposing critical weaknesses in workforce planning and resulting in acute staffing shortages. This study presents a comprehensive economic evaluation of large-scale, rapid ICU workforce upskilling as a strategic response to such pressures. Specifically, we assess the cost-effectiveness, economic sustainability, and resilience-building potential of these interventions during crisis conditions.

Methods

C19_SPACE, a Europe-wide upskilling initiative led by the European Society of Intensive Care Medicine (ESICM), was implemented across 24 countries between 2020 and 2021. A societal economic evaluation and return on investment (ROI) was calculated through deterministic modeling and validated using probabilistic sensitivity analysis across a range of plausible scenarios, including variations in patient throughput, training efficacy, and healthcare system parameters.

Results

The total societal investment in the program was €20.1 million, translating to an average cost of €1146 per participant and €1720 per Quality-Adjusted Healthcare Worker (QAHW). Deterministic modeling estimated an ROI of 478%, with program costs fully recovered in just 5.1 days. Probabilistic sensitivity analysis confirmed the robustness of these findings, with a mean ROI of 455% (95% CI 130–1029%) and a median break-even point of 5.4 days (95% CI 2.66–13.04 days).

Conclusion

Rapid, structured ICU workforce upskilling initiatives deliver substantial economic returns and significantly expands healthcare capacity. Strategic investment in emergency workforce upskilling is economically sound and crucial for healthcare system resilience during future crises.