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Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression

  • Klaus Kaier (a1), Thomas Heister (a1), Edith Motschall (a1), Philip Hehn (a1), Tobias Bluhmki (a2) and Martin Wolkewitz (a1)...

Abstract

The impact of mechanical ventilation on the daily costs of intensive care unit (ICU) care is largely unknown. We thus conducted a systematic search for studies measuring the daily costs of ICU stays for general populations of adults (age ≥18 years) and the added costs of mechanical ventilation. The relative increase in the daily costs was estimated using random effects meta regression. The results of the analyses were applied to a recent study calculating the excess length-of-stay associated with ICU-acquired (ventilator-associated) pneumonia, a major complication of mechanical ventilation. The search identified five eligible studies including a total of 54 766 patients and ~238 037 patient days in the ICU. Overall, mechanical ventilation was associated with a 25.8% (95% CI 4.7%–51.2%) increase in the daily costs of ICU care. A combination of these estimates with standardised unit costs results in approximate daily costs of a single ventilated ICU day of €1654 and €1580 in France and Germany, respectively. Mechanical ventilation is a major driver of ICU costs and should be taken into account when measuring the financial burden of adverse events in ICU settings.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Klaus Kaier, E-mail: kaier@imbi.uni-freiburg.de

References

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1.Maragakis, LL, Perencevich, EN and Cosgrove, SE (2008) Clinical and economic burden of antimicrobial resistance. Expert Review of Anti-infective Therapy 6, 751763.
2.Dasta, JF et al. (2005) Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical Care Medicine 33, 12661271.
3.Moerer, O et al. (2007) A German national prevalence study on the cost of intensive care: an evaluation from 51 intensive care units. Critical Care 11, R69.
4.Kahn, JM et al. (2008) Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Medical Care 46, 12261233.
5.Jacobs, P et al. (2001) Descriptive patient data as an explanation for the variation in average daily costs in intensive care. Anaesthesia 56, 643647.
6.Moran, JL et al. (2004) Cost calculation and prediction in adult intensive care: a ground-up utilization study. Anaesthesia & Intensive Care 32, 787797.
7.Harbord, RM and Higgins, JP (2008) Meta-regression in Stata. Stata Journal 8, 493519.
8.Sharp, S (1998) Meta-analysis regression. Stata Technical Bulletin 42, 68. Available at https://www.stata-press.com/journals/stbcontents/stb42.pdf (Accessed 15 October 2019).
9.Stanley, TD and Doucouliagos, H (2013) Better Than Random: Weighted Least Squares Meta-Regression Analysis. Geelong, Vic: Deakin University, Faculty of Business and Law, School of Accounting, Economics and Finance.
10.Bluhmki, T et al. (2018) Estimation of adjusted excess length-of-stay associated with ventilation-acquired pneumonia in intensive care: a multistate approach accounting for time-dependent mechanical ventilation. Biometrical Journal 60, 11351150.
11.Schumacher, M et al. (2013) Hospital-acquired infections – appropriate statistical treatment is urgently needed!. International Journal of Epidemiology 42, 15021508.
12.Heister, T, Kaier, K and Wolkewitz, M (2017) Estimating the burden of nosocomial infections: time dependency and cost clustering should be taken into account. American Journal of Infection Control 45, 9495.
13.Lefrant, JY et al. (2015) The daily cost of ICU patients: a micro-costing study in 23 French Intensive Care Units. Anaesthesia Critical Care & Pain Medicine 34, 151157.
14.Bock, J-O et al. (2015) Ermittlung standardisierter Bewertungssätze aus gesellschaftlicher Perspektive für die gesundheitsökonomische Evaluation. Das Gesundheitswesen 77, 5361.
15.Halpern, NA and Pastores, SM (2010) Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Critical Care Medicine 38, 6571.
16.Gooch, RA and Kahn, JM (2014) ICU bed supply, utilization, and health care spending: an example of demand elasticity. JAMA 311, 567.
17.Wunsch, H et al. (2008) Variation in critical care services across North America and Western Europe. Critical Care Medicine 36, 2787-e8.
18.Wunsch, H et al. (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. American Journal of Respiratory and Critical Care Medicine 183, 16661673.
19.Negrini, D et al. (2006) International Programme for Resource Use in Critical Care (IPOC) – a methodology and initial results of cost and provision in four European countries. Acta Anaesthesiologica Scandinavica 50, 7279.
20.Heister, T, Wolkewitz, M and Kaier, K (2018) Estimating the additional costs of surgical site infections: length bias, time-dependent bias, and conditioning on the future. Journal of Hospital Infection 99, 103104.
21.Kaier, K, Mutters, NT and Wolkewitz, M (2019) Measuring the financial burden of resistance: what should be compared? Clinical Infectious Diseases 69, 1082.
22.Kaier, K, Wolkewitz, M and Heister, T (2018) Estimating the attributable costs of hospital-acquired infections requires a distinct categorization of cases based on time of infection. American Journal of Infection Control 46, 729.
23.Stewardson, AJ et al. (2016) The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study. Eurosurveillance 21, pii=30319. doi: 10.2807/1560-7917.
24.Shepard, J et al. (2013) Financial impact of surgical site infections on hospitals: the hospital management perspective. JAMA Surgery 148, 907914.
25.Macedo-Vinas, M et al. (2013) Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital: excess length of stay and costs. Journal of Hospital Infection 84, 132137.
26.Sosa-Hernández, O et al. (2019) Incidence and costs of ventilator-associated pneumonia in the adult intensive care unit of a tertiary referral hospital in Mexico. American Journal of Infection Control 47, e21e25.

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Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression

  • Klaus Kaier (a1), Thomas Heister (a1), Edith Motschall (a1), Philip Hehn (a1), Tobias Bluhmki (a2) and Martin Wolkewitz (a1)...

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