The Cost of Critical Care Introduction

 “…there are certain ethical concerns and underlying missions in both individual institutions and society that often need to be met irrespective of the economic impact. If society deems health and medical care as a basic human right and worthy endeavor that must be pursued with other societal goals, economic concerns and cost-effectiveness considerations will wane.” [Chatlin 1998]  

It is a universally accepted maxim: technology is the main driver of health care inflation. Intensive care is, by definition, the zenith of (life support) technologies. Intensive care devours hospital resources: there is huge expenditure on salaries, due to the high nurse : patient ratio, the most expensive drugs – particularly antimicrobials, a continuous train of newer technologies that promise to prolong the lives of the sickest patients. In the past the ICU has been regarded as “immune” from economic scrutiny. Times are changing. There is a strong realisation that intensive care units can become financial “black holes” and that to merely “prolonging the inevitable” in many patients represents a waste of resources. This and the next section focus on the drive to contain costs in intensive care units, using an evidence based approach. We will focus on published economic evaluations and try and answer a series of questions:

1. Can we justify the cost of Intensive Care?

2. Does evidence based medicine have a role in economic, as well as clinical, evaluations?

3. What is the role of cost-effectiveness analysis?

4. Can we use evidence based economic evaluation as a management tool in ICU?

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