Cost analysis of intensive glycemic control in critically ill adult patients.

STUDY OBJECTIVES To assess the effect of an intensive glycemia management protocol on the cost of care of a heterogeneous population of critically ill adult patients. DESIGN Economic analysis of a 1,600-patient "before-and-after" study of intensive glycemia management. SETTING Fourteen-bed mixed medical-surgical adult ICU of a university-affiliated community teaching hospital. PATIENTS Eight hundred consecutive admissions to the ICU prior to the institution of an intensive glucose management protocol were compared to the first 800 patients admitted to the ICU following institution of the protocol. INTERVENTIONS Cost data were analyzed using the comprehensive database of the ICU as well as other hospital data repositories. MEASUREMENTS AND RESULTS The ICU database was used to quantify the major components of the cost of care. The analysis includes costs associated with ICU and non-ICU patient days, ventilator days, and laboratory, pharmacy, and radiology services. Comparing the baseline and treatment periods, there were decreases in patient days in the ICU; ventilator days; total laboratory, pharmacy and radiology costs; and post-ICU hospital length of stay. The net annualized decrease in costs during the treatment period was USD 1,339,500, or USD 1,580 per patient. CONCLUSIONS The institution of a program to intensively monitor glucose levels and treat even modest hyperglycemia in the ICU was associated with substantial cost savings. This finding, in conjunction with the previously demonstrated improvement in mortality and morbidity, strongly supports the adoption of this intervention as a standard of care in the ICU.