ANALYSIS OF COSTS IN A PEDIATRIC ICU

Objective: To analyze the actual cost of pediatric intensive care and its different components, particularly the differences between various patient groups, with special reference to the variable cost and the e lements included in it. Design: Prospective, observational study. Sett ing: Multidisciplinary 12-bed pediatric intensive care unit (PICU) in a tertiary university hospital. Patients: 495 admissions to the unit o ver 17 consecutive months; 64.2 % were medical patients and 35.8 % wer e surgical patients; the mean (SE) stay in the PICU was 6.6 +/- 0.3 da ys. Measurements and results: The fixed cost per day per patient was c alculated, including the costs of physicians, nurses, auxiliary and ot her personnel who worked during the study period, and the costs of str uctural depreciation, maintenance, consumption, and disposable materia l. The variable cost was individually calculated from the costs of rou tine procedures and also included expenditure on pharmaceuticals, bloo d products, biochemical, hematological, and bacteriologic tests, radio logy, image diagnosis procedures, and other procedures. The Physiologi c Stability Index (PSI) was obtained in the first 24 h after admission . The mean fixed cost per patient per day was u. s. $ 608, which repre sents 72 % of the total patient cost during this study; 86 % of this a mount was for personnel (58 % for nurses and auxiliary staff). Variabl e costs came to 28 % of the total amount, and were $ 218 +/- 100 (M +/ - SEM) per patient per day. In addition to the costs of their longer s tay in the PICU, the daily variable costs of nonsurvivors were higher than those of survivors ($ 542 +/- 52 vs $ 179 +/- 7; p < 0.001). We c lassified the patients into four groups according to their PSI score i n the first 24 h; variable daily costs increased (p < 0.05) in all com parisons with the PSI level: group I: < 4 points ($ 155 +/- 0.5), grou p II: 5-9 points ($ 210 +/- 13), group III: 10-14 points ($ 324 +/- 54 ), group IV: > 15 points ($ 480 +/- 42). However, this pattern was not found for all resources: the cost of treatment techniques and biochem ical and hematological tests increased, but the consumption of antibio tics, parenteral nutrition, blood products, and bacteriologic tests re ached their maximum level in groups I-III and radiology was not signif icantly influenced by PSI level. Conclusions: The cost of personnel wa s the biggest factor in intensive care costs: 62.4 % of the total cost s. Nonsurvivors generated 3 times the mean variable daily expenditure on survivors and had longer stays in the PICU. The increase in PSI sco re on the first day was associated with a global increase in variable costs. The cost of treatment techniques significantly increased as the illness became more severe but consumption of antibiotics and parente ral nutrition and use of bacteriologic tests and radiology did not.