Microcosting study of ICU costs in three European countries

Introduction

A recently published study by Negrini and colleagues in 2006 suggested strongly diverging patient-related costs per ICU day between Western European countries. We tried to verify these results by performing a cost analysis in three European countries.

Methods

We conducted a retrospective cost study in one German, one Italian and three Dutch adult medical–surgery ICUs, from the hospital perspective. A microcosting approach was used; that is, all relevant resources were identified and valued at the most detailed level. Resource use was divided into patient-related and nonpatient-related care. Patient-related care comprised diagnostics, consumables, inpatient stay and labour, while nonpatient care included overheads and capital. Resource use was primarily derived from hospital administrative databases, while unit costs were acquired from financial hospital databases and hospital pharmacy databases, using 2006 as the reference year.

Results

Average patient-related care costs per ICU day were €1,040 in Germany, €1,333 in Italy and €1,243 in The Netherlands. Hence these costs are similar in all three countries, although there are differences between the considered patient-related care categories (for example, nursing and medical staff). The total average ICU cost per day (patient-related care + nonpatient-related care) amounted to €1,225 in Germany, €1,472 in Italy, and €1,911 in The Netherlands. Variations in overheads and capital costs might be (partly) caused by differences in the accounting and financing systems. For example, unlike in Italy and The Netherlands, in Germany most capital costs of public hospitals are paid by the states and hence do not represent any cost to the hospital.

Conclusion

Our results indicate that the patient-related care costs of intensive care in Germany, Italy, and The Netherlands are similar from the hospital perspective.