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

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.

<p>Incremental Costs Associated with Length of Hospitalization Due to Viral Pneumonia: Impact of Intensive Care and Economic Implications of Reducing the Length of Stay in the Era of COVID-19</p>

“…The first study, a meta-regression analysis, showed that iMV substantially increased daily ICU costs by 25% and suggested that LOS is likely to be an important contributor to the iMV cost component. 5 However, that study not only noted the paucity of information available on the economic impact of iMV, but also appeared to focus on duration of LOS as an effect of ventilator-assisted pneumonia. That focus is in contrast to the current study, which considered use of iMV as treatment for a primary diagnosis of pneumonia.…”

“…Many of these patients require an extended length-of-stay (LOS) and therapy that often necessitates management within the setting of an intensive care unit (ICU), including the need for invasive mechanical ventilation (iMV), [2][3][4] which has previously been suggested to be a major driver of ICU costs for other disease states. 5,6 Current responses to the immediate need for care of COVID-19 patients include a renewed focus on existing management strategies that may be appropriately applied to these patients and rapid development of new pharmacologic agents to improve patient outcomes and reduce LOS. A reduction in LOS enables allocation of scarce resources such as the need for freeing hospital beds during a surge.…”

“…Many of these patients require an extended length-of-stay (LOS) and therapy that often necessitates management within the setting of an intensive care unit (ICU), including the need for invasive mechanical ventilation (iMV), 2–4 which has previously been suggested to be a major driver of ICU costs for other disease states. 5 , 6 …”

How to allocate intensive care resources during the COVID-19 pandemic: medical triage or a priori selection?

“…Hospital treatment is expensive, and the costs of intensive care amount to around 20% of the total hospital expenditure ( 4 , 5 ). Moreover, during the ICU stay, mechanical ventilation of the lungs could increase the daily costs by additional 26% ( 6 ). In the USA, ventilatory support for a COVID-19 patient lasting longer than 96 hours has an estimated median cost of $ 88 114.…”

Implementation of High-Flow Nasal Cannula Therapy Outside the Intensive Care Setting

“…8 Hospitals struggle to have enough ICU beds available for critically ill patients, especially during high peak seasons such as influenza or during pandemics, and ICU costs are a significant component of total health care costs. [9][10][11][12][13] It is essential to establish options for delivering safe and effective respiratory therapy to patients outside the ICU setting.…”