The Impact of Mortality on Total Costs Within the ICU

The Impact of Mortality on Total Costs Within the ICU

Kramer, A A et al
Critical Care Medicine:  September 2017 - Volume 45 - Issue 9 - p 1457–1463

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.