The financial cost of intensive care in Australia: a multicentre registry study

Intensive care unit (ICU) care is expensive.1 We estimated the financial costs, from an operational perspective, of providing care to patients admitted to Australian ICUs and how they vary according to bed number, unit occupancy, and ICU type (tertiary, metropolitan, and rural/regional public hospitals, and private hospitals).

The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resources Evaluation (CORE) Critical Care Resources (CCR) registry collects information and each financial year reports aggregate data on ICU activities and resources, a declared quality assurance activity under the federal Health Insurance (Quality Assurance Confidentiality) Amendment Act 1992. The annual survey for collecting these data is completed by ICU heads of department or their nominated representatives.2 We analysed data for Australian ICUs from the 2013/14 CCR survey, which included questions (additional to those in the regular survey) on the major components of expenditure (cost blocks).3 Participating ICUs reported annual costs for selected budget items and total ICU expenditure (Supporting Information, table 1); capital expenditure, organisational overhead costs, and equipment costs were not included.3 The cost per patient bed‐day, the annual cost per ICU bed, and total annual costs were calculated (further details: Supporting Information). The study was approved by the Alfred Health Human Research Ethics Committee (reference, 449/19).

The survey was forwarded to 181 Australian ICUs in October 2014. Complete costing data were received from 36 ICUs in 36 hospitals, accounting for 500 ICU beds (about 25% of ICU beds in Australia).4 The characteristics of contributing and non‐responding ICUs were similar (Supporting Information, tables 2 and 3).

The mean cost per patient bed‐day for all contributing ICUs was $4375 (standard deviation, $1157; 2019 consumer price index equivalent, $4875), the median cost was $4221 (interquartile range, $3436–$5286) (Box 1). Higher ICU bed number (R² = 0.23; P = 0.004) and occupancy (R² = 0.28; P = 0.002) were each significantly associated with lower costs per patient bed‐day (Box 2); bed number did not influence annual cost per bed (Supporting Information, figure 1).

The estimated total annual operational cost for ICU care in Australia was $2119 million, about 0.15% of gross domestic product (GDP) and 1.4% of total health care costs (Supporting Information, tables 4 and 5). Staffing accounted for about 80% of ICU operational costs (Supporting Information, table 6). Larger ICUs were associated with lower costs for medical staff (P = 0.023) but not for nursing staff (P = 0.05) (Supporting Information, figures 2 and 3).

Our estimated mean cost per ICU patient bed‐day is similar to the mean total cost of acute hospital separations in Australia during 2013/14 (about $5000).5 ICU per patient‐day costs have been reported to be lower in France and Germany, similar in the United Kingdom, and higher in the United States (Supporting Information, table 7). In the United States, critical care accounts for 4.1% of all private and government health expenditure and 0.66% of GDP,6 a difference that may be attributable to the difference in ICU bed numbers (Australia, 8.1 per 100 000 population;2 United States, 20 per 100 000 population7).

We analysed self‐reported ICU operational costs for 36 of 181 Australian ICUs. Costs related to specific diseases, treatments, and lengths of ICU stay could not be investigated. We included six ICUs in which fewer than 20% of patients required artificial ventilation and a high proportion of tertiary ICUs, which have somewhat lower per patient‐day costs. This may explain why our estimate was slightly lower than the 2019 Independent Hospital Pricing Authority estimate, based on patient‐level data, of $210 per bed‐hour, or $5040 per ICU bed‐day.8 As ICU costs declined with size and occupancy, increasing ICU size may have improved health care system efficiency.