Bigger is cheaper when it comes to intensive care

Intensive care units cost the Australian healthcare system $2.1 billion annually, with larger units with increased occupancy associated with lower costs, according to the authors of a research letter published online today by the Medical Journal of Australia.

Dr. Edward Litton, an intensive care consultant at Fiona Stanley Hospital in Perth, and colleagues analyzed data for Australian intensive care units (ICUs) from the 2013/14 the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resources Evaluation, which included questions (additional to those in the regular survey) on the major components of expenditure.

Participating ICUs reported annual costs for selected budget items and total ICU expenditure; capital expenditure, organizational overhead costs, and equipment costs were not included. The cost per patient bed-day, the annual cost per ICU bed, and total annual costs were calculated. Complete costing data were received from 36 ICUs in 36 hospitals, accounting for 500 ICU beds (about 25% of ICU beds in Australia).

"The mean cost per patient bed-day for all contributing ICUs in 2013-2014 was $4375. Today in 2019 this would almost $5000," Litton and colleagues reported.

"Higher ICU bed number and occupancy were each significantly associated with lower costs per patient bed-day; bed number did not influence annual cost per bed.

"The estimated total annual operational cost for ICU care in Australia was $2.119 billion, about

0.15% of gross domestic product and 1.4% of total health care costs. Staffing accounted for about 80% of ICU operational costs. Larger ICUs were associated with lower costs for medical staff but not for nursing staff."

The authors concluded that: "As ICU costs declined with size and occupancy, increasing ICU size may have improved health care system efficiency."