Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 17 , ISSUE 5 ( October, 2013 ) > List of Articles

RESEARCH ARTICLE

A prospective audit of costs of intensive care in cancer patients in India

Jigeeshu V. Divatia

Keywords : Cost analysis, costs, effective cost per survivor, health economics, intensive care, length of stay

Citation Information : Divatia JV. A prospective audit of costs of intensive care in cancer patients in India. Indian J Crit Care Med 2013; 17 (5):292-297.

DOI: 10.4103/0972-5229.120321

License: CC BY-ND 3.0

Published Online: 01-10-2013

Copyright Statement:  Copyright © 2013; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The costs of healthcare are increasing. Intensive care poses largest burden on the hospital budget, even in developed countries. We attempted to find out the costs of intensive care in an Indian cancer hospital. Materials and Methods: Cost data was prospectively collected for patient-related and non-patient-related activities in a mixed surgical, medical cancer ICU. Demographic data, source, reason, and length of ICU stay were recorded. Total per day costs, costs for patients admitted from wards and operating rooms, and effective cost per survivor (ECPS) were calculated. Results: Data was collected for 101 consecutive ICU patients. Fifty-five patients were admitted after surgery (total patient hours 3485 i.e., 145.21 patient days). The mean (SD) intensive care unit length of stay (ICU LOS) was 64.84 (58.47) hrs. (8.25 to 552). Fifty-three patients survived to discharge. Forty-six patients were admitted from wards (hematooncology) or casualty and stayed 3980.25 patient hrs (165.84 patient days). The mean (SD, range) ICU LOS was 106.84 (64.05, 1-336) hrs. Of these, 26 patients survived to discharge. The effective cost per survivor (ECPS) was significantly higher for patients admitted from wards. [Rs. 83,558 = 00 (USD 1856.84) vs. Rs. 15,049 = 00 (USD 334.42)]. Conclusion: The costs of ICU place much higher burden on the patients as the Indian GDP and per capita income is much lower. Better selection process is needed for hemato-oncology patients for ICU admission for better utilization of scarce resources. Such data as ours can be used to inform families and physicians about anticipated costs.


PDF Share
  1. Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: An analysis of bed numbers, use, and costs. Crit Care Med 2004;32:1254-9.
  2. Bloomfield EL. The impact of economics on changing medical technology with reference to critical care medicine in the United States. Anesth Analg 2003;96:418-25.
  3. Gyldmark M. A review of cost studies of intensive care units: Problems with the cost concept. Crit Care Med 1995;23:964-72.
  4. Carlon GC. Just say no. Crit Care Med 1989;17:106-7.
  5. Schapira DV, Studnicki J, Bradham DD, Wolff P, Jarrett A. Intensive care, survival, and expense of treating critically ill cancer patients. JAMA 1993;269:783-6.
  6. Azoulay E, Afessa B. The intensive care support of patients with malignancy: Do everything that can be done. Intensive Care Med 2006;32:3-5.
  7. Available from: http://www.who.int/whosis/database/core/core_select_process.cfm?countries=allandindicators=nha. [Last accessed on 2008 Jan 9].
  8. Parikh CR, Karnad DR. Quality, cost, and outcome of intensive care in a public hospital in Bombay, India. Crit Care Med 1999;27:1754-9.
  9. ESICM Working group on Cost effectiveness in intensive care medicine. Available from: http://www.esicm.org, on request [Last accessed on 2012 Aug 9].
  10. Courtney DM, Aldeen AZ, Gorman SM, Handler JA, Trifilio SM, Parada JP, et al. Cancer-associated neutropenic fever: Clinical outcome and economic costs of emergency department care. Oncologist 2007;12:1019-26.
  11. Merz TM, Schär P, Bühlmann M, Takala J, Rothen HU. Resource use and outcome in critically ill patients with hematological malignancy: A retrospective cohort study. Crit Care 2008;12:R75.
  12. Edbrooke DL, Hibbert CL, Kingsley JM, Smith S, Bright NM, Quinn JM. The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999;27:1760-7.
  13. Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, et al. Hospitalized cancer patients with severe sepsis: Analysis of incidence, mortality, and associated costs of care. Crit Care 2004;8:R291-8.
  14. Rossi C, Simini B, Brazzi L, Rossi G, Radrizzani D, Iapichino G, et al. Variable costs of ICU patients: A multicenter prospective study. Intensive Care Med 2006;32:545-52.
  15. Edbrooke DL, Stevens VG, Hibbert CL, Mann AJ, Wilson AJ. A new method of accurately identifying costs of individual patients in intensive care: The initial results. Intensive Care Med 1997;23:645-50.
  16. Edbrooke D, Hibbert C, Ridley S, Long T, Dickie H. The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing. Anaesthesia 1999;54:110-20.
  17. Moerer O, Plock E, Mgbor U, Schmid A, Schneider H, Wischnewsky MB, et al. A German national prevalence study on the cost of intensive care: An evaluation from 51 intensive care units. Crit Care 2007;11:R69.
  18. Truog RD, Brock DW, Cook DJ, Danis M, Luce JM, Rubenfeld GD, et al. For the Task Force on Values, Ethics, and Rationing in Critical Care (VERICC). Rationing in the intensive care unit. Crit Care Med 2006;34:958-63.
  19. Available from: http://indiabudget.nic.in/es2007-08/chapt2008/chap12.pdf. [Last accessed on 2013 May 05].
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.