Association between strained ICU capacity and healthcare costs in Canada: A population-based cohort study

• Published in: Journal of critical care Vol. 51; pp. 175 - 183
• Main Authors: Tran, Dat T., Thanh, Nguyen X., Opgenorth, Dawn, Wang, Xiaoming, Zuege, Danny, Zygun, David A., Stelfox, Henry T., Bagshaw, Sean M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2019; Elsevier Limited
• Subjects: Adult; Aged; Alberta; Ambulatory care; Cohort analysis; Cohort Studies; Costs; Critical care; Critical Care - economics; Female; Health Care Costs - statistics & numerical data; Health care expenditures; Health economics; Health services; Hospital Bed Capacity - statistics & numerical data; Hospital Costs; Hospitalization; Hospitalization - economics; Humans; Intensive care; Intensive Care Units - economics; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Organization; Outcome; Patients; Population; Population-based studies; Retrospective Studies; Utilization; Alberta; Canada; Critical care; Costs; Health economics; Utilization; Organization; Outcome
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.02.025

Intensive care is resource intensive, with costs representing a substantial quantity of total hospitalization costs. Strained ICU capacity compromises care quality and adversely impacts outcomes; however, the association between strain and healthcare costs has not been explored.
Population-based cohort study performed in 17 adult ICUs in Alberta, Canada. Data were captured on hospitalizations, ambulatory care, physician services and drug dispenses occurring 1-year before and 1-year after index ICU admission. Strain was defined as occupancy ≥90%; with 21 additional definitions evaluated. Patients were categorized as strain and non-strain admissions. Costs attributable to strain, were calculated as difference-in-difference costs using propensity-score matching.
30,557 patients were included (strain: 11,830 [38.7%]; non-strain: 18,727 [61.3%]). At 1-year, strain admissions had adjusted-incremental per-patient cost of CA$9406 (95%CI, $5654-13,157) compared to non-strain admissions, due to hospitalization costs (CA$7930; 95%CI, $4553-11,307) and physician claims (CA$844; 95%CI, $430–1259). This equated to CA$111.3 million (95%CI, $66.9–155.6 million) in excess attributable costs. Strain portended longer hospitalization (3.3 days; 95%CI, 1.1–5.5); and more ambulatory visits (1.0; 95%CI, 0.1–2.0) and physician claims (9.5; 95%CI, 6.2–12.7). Incremental costs were robust across strain definitions.
Admissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.
•ICU admission during strain incurred a 1-year incremental cost of CA $9,406 compared to patients admitted during non-strain.•Incremental costs were largely attributed to longer duration of hospitalization and physician claims.•Incremental costs were robust in analyses using a spectrum of definitions for strain.