Cost of care in the ICU of a University Hospital in Bogotá D.C.

Costos de atención en UCI de un Hospital universitario de Bogotá D.C.

A retrospective descriptive study was carried out that evaluated the cost generated by the care of patients in a mixed-type ICU in a university hospital. The objective was to establish in detail each of the resources consumed taking the perspective of the service provider. We evaluated the clinical history of all patients treated during the period between October 1, 2003 and October 31, 2004, assigning them according to the primary diagnosis that justified the admission to the unit in five groups that we call diagnostic , related as follows: 1) cardiovascular medical, 2) surgical cardiovascular, 3) sepsis of medical management, 4) sepsis of surgical management and 5) trauma. The consumption of resources was determined from the sales invoice, but the applied value corresponds to the purchase price of the input. We included 190 patients from whom it was not possible to complete the financial information in 43, so that in the end the sample size was 147. In our study, the highest consumption of resources was found in those who were admitted for sepsis and in all the groups that had greater weight were the payment of the human resource and in the second instance the nutrition, behavior that follows the tendency described in articles written in countries with high technological development, in spite of the clear differences in the systems of attention in health. Conclusion: the distribution of the cost components of care in the ICU analyzed is in agreement with other foreign studies. The development in the information systems and the detailed cost knowledge constitute an indispensable tool for decision making. Abbreviations: ICU, intensive care unit; GDR, related diagnostic group; APACHE II, Acute physiological and chronic health evaluation; DE, standard deviation. EAPB, Companies that Manage Profit Plans.

1. Noseworthy TW, Konopad E, ShustackA, Johnston R, Grace M. Cost accounting of adult intensive care: methods and human and capital inputs. Crit Care Med. 1996 Jul;24(7):1168-72.

2. Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, Harvey MA, Kelley MA, Kelly KM, Rudis MI, St AndreAC, Stone JR, Teres D, Weled BJ; American College of Critical Care Medicine Task Force on Models of Critical Care Delivery. The American College of Critical Care Medicine Guidelines for the Defintion of an Intensivist and the Practice of Critical Care Medicine. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med. 2001 Oct;29(10):2007-19.

3. Glance LG, Osler T, Shinozaki T. Intensive care unit prognostic scoring systems to predict death: a cost-effectiveness analysis. Crit Care Med. 1998 Nov;26(11):1842-9.

4. Atkinson S, Bihari D, Smithies M, Daly K, Mason R, McColl I. Identification of futility in intensive care. Lancet. 1994 Oct 29;344(8931):1203-6.

5. Ridley S. Biggam M, Shone P: A cost-benefit analysus of intensive therapy. Anaesthesia 1993; 48:14-19.

6. Joint Position Statement: Essential provisions for critical care in health system refor. Crit Care Med 1994; 22:2017- 2019.

7. Esserman L, Belkora J, Lenert L. Potentially ineffective care. A new outcome to assess the limits of critical care. JAMA. 1995 Nov 15;274(19):1544-51.

8. Gyldmark M. A review of cost studies of intensive care units: problems with the cost concept. Crit Care Med. 1995 May;23(5):964-72.

9. Heyland DK, Gafni A, Kernerman P, Keenan S, Chalfin D. How to use the results of an economic evaluation. Crit Care Med. 1999 Jun;27(6):1195-202.

10. Parikh CR, Karnad DR. Quality, cost, and outcome of intensive care in a public hospital in Bombay India: Crit Care Med. 1999 Sep;27(9):2032-3.

11. Knaus WA, Draper EA; Wagner DP, et al: APACHE II: Severity of disease classification system. Crit Care Med 1985; 13:818-829.

12. Burchardi H, Schneider H. Economic aspects of seversepsis: a review of intensive care unit costs, cost of illness and cost effectiveness of therapy. Pharmacoeconomics. 2004;22(12):793-813.