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  • The care of critically ill patients in the modern ICU results in a large societal burden in terms of both manpower and monetary cost.
  • The high cost of critical care can largely be attributed to high overhead costs (e.g., need for experienced staff and expensive equipment), high resource utilization (e.g., drugs, lab tests, and complex imaging procedures), and an ever-growing demand for ICU services.
  • Complex economic analysis of health care decision making can be reduced to two fundamental questions that need to be answered: First, “Is a therapy worth using when compared with the alternatives?" The second question is broader and asks “Should a portion of available health care resources be allocated to a given therapy or program?”
  • Routine incorporation of Cost Effectiveness studies is important to the conduct of high quality clinical trials research in the intensive care unit. Inclusion of cost effectiveness gives the clinician the opportunity to fully assess the effect of a new therapy in the ICU.

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The care of critically ill patients in the modern ICU results in a large societal burden in terms of both manpower and monetary cost. The high cost of critical care can largely be attributed to: high overhead costs (e.g., need for experienced staff and expensive equipment), high resource utilization (e.g., drugs, lab tests, and complex imaging procedures), and an ever-growing demand for ICU services. With the continuing rise in health care costs, there is an ever-increasing need to establish whether new therapies are not only efficacious, but also cost effective. The need for cost-effectiveness evaluations is spread throughout medicine, but the issue of cost effectiveness is especially important in critical care medicine. While ICU beds account for only about 10% of all inpatient hospital beds, ICU costs in the U.S. exceed $60 billion annually, and consume up to one third of all hospital costs.1 Furthermore, attempts to reduce ICU costs by other mechanisms, such as reduction in length of stay, have proved to be difficult.2 While access to new therapies is being tied increasingly to cost, physicians continue to be skeptical and suspicious of cost analyses. In large part, this skepticism is prompted by the variable quality of earlier cost analyses. However, skepticism is also due to the lack of familiarity many physicians have with the general principles of health economics. The U.S. Public Health Service (USPHS) attempted to set standards for the conduct of rigorous cost-effectiveness analyses in medicine.3–5 In critical care medicine, the American Thoracic Society (ATS) established specific guidelines for the conduct of cost-effectiveness analyses based on the USPHS recommendations.6 These standards have the potential to greatly improve the quality of future cost-effectiveness studies. However, if clinicians do not understand and embrace the principles of cost effectiveness, it is likely that such studies will continue to be viewed simply as ammunition for nonclinician administrators in the battle to restrict physician freedom of choice and to control clinical decision making.

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In this chapter, we ...

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