Critical Care Economics

Health care costs represent a large percentage of the gross domestic product all over the world. According to the National Health Statistics Group, health care expenditure in the United States accounted for as much as 14% of the gross national product in 1992 and it is projected to reach 30% by 2030. The intensive care unit (ICU) represents the hallmark of highly competent modern hospitals, offering highly trained staff and life-saving technology and it is also one of the most expensive units in the hospital. Expenses related to running the ICU have been estimated at approximately 20% of total hospital costs, despite only representing 10% of all hospital beds. Assisted mechanical ventilation particularly affects the high costs in the ICU. Actually, a mere of 1 million persons per year receive mechanical ventilation during their stay in the ICU. A variety of different approaches to stabilize or reduce costs in the ICU have been suggested. Reducing the length of ICU stay, improving the patient’s condition to prevent co-morbid events, and introducing specialized teams to round in the ICU are some of the recent actions taken in the search for cost-effective therapies. The aim of this article is to provide some of the basic principles of economic assessment in critically ill patients and present an overall review of the strategies followed to reduce costs and resource usage in the ICUs around the world. From Universidad Autónoma de Chihuahua, Chihuahua, México (Alma Rivera), College of Pharmacy, The Ohio State University and College of Pharmacy, The University of Texas, Austin, Texas, USA (Joseph F. Dasta), and The University of Texas Health Science Center at Houston and The University of Texas Medical Branch at Galveston, St. Luke’s Episcopal Hospital, Houston, Texas, USA (Joseph Varon). Address for correspondence: Joseph Varon, MD, FACP, FCCP, FCCM