Intensive Care Costing Methodology: Cost Benefit Analysis of Mask Continuous Positive Airway Pressure for Severe Cardiogenic Pulmonary Oedema

Abstract

Costing data for intensive care admissions is important, not only for unit funding, but also for cost outcome analysis of new therapies. This paper presents an intensive care episode costing methodology using the example of a cost-benefit analysis of mask CPAP for severe cardiogenic pulmonary oedema (CPO). This analysis examines the intervention of admitling all patients with severe CPO to the intensive care unit for mask CPAp, compared with the previous practice of admitting only patients failing conventional non-CPAP treatment and requiring mechanical ventilation. The episode costs were determined from a prospective study which showed mask CPAP reduced the need for mechanical ventilation from 35% to 0%. The mean cost of a mask CPAP episode was $1,156, with a mean stay of 1.2 days, compared with ventilated patients, $5,055 and 4.2 days. The major contributors to cost in both groups were nursing and medical salaries, and hospital overheads. The cost of previous estimated yearly caseload of 35 ventilated patients ($176,925) was greater than the cost associated with an increased caseload of 100 mask CPAP patients ($1J5,600). We conclude that, despite an increase in admissions, mask CPAP for severe CPO is cost-effective.

A new method of accurately identifying costs of individual patients in intensive care: the initial results

“…Ridley et al [18] reported fixed costs which were 11 % of the total costs from a study carried out in the United Kingdom, Holt et al [19] reported that 26 % of the total costs for ventilated patients were fixed from a study carried out in Australia and Halpern et al [20] reported that indirect costs were 33 % of the total costs from a study carried out in the United States. In this study, we report non-patient-related costs of 49 % of the total costs of care.…”

Acidemia does not affect outcomes of patients with acute cardiogenic pulmonary edema treated with continuous positive airway pressure

“…CPAP has proven to be easier to use, quicker to implement in clinical practice and to carry smaller associated costs in comparison with non-invasive ventilation (NIV) [2]. In light of these findings, CPAP has also been also used to treat ACPE patients outside the intensive care unit or the Emergency Department, as in the general ward or during prehospital care [3].…”

Charging for Intensive Care using Direct Nursing Hours as the Cost Marker

“…Nursing costs in intensive care are the biggest staff cost and form about 30-40% of the total costs 8,9 . Intuitively, those working at the bedside realise that a direct relationship exists between the severity of illness and the nursing time needed.…”