Intensive care use in a developing country: a comparison between a Tunisian and a French unit

Objectives: compare the variations in intensive care (ICU) outcome in relat ion to variations in resources utilization and costs between a developed an d a developing country with different medical and economical conditions. Design and setting: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. Patients: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. Measurements: We prospectively recorded demographic, physiologic, and treat ment information for all patients, and collected data on the two ICU struct ures and facilities Costs and ICU outcome were compared in the overall popu lation, in three groups of severity indexes and among selected diagnostic g roups. Results: Tunisian patients were significantly younger, were in better healt h previously and were less severely ill at ICU admission (p < 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5 %; p < 0.01) and received more treatment (p < 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range , Tunisian and French patients had similar mortality rates, While the forme r received less therapy throughout their ICU stays (p < 0.05). Conversely i n the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. Conclusion: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this dif ference appeared in relation to shorter lengths of ICU stay, and a poorer e fficiency and cost-effectiveness was suggested in the mid-range severity gr oup. Differences in economical constraints may partly explain differences i n ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care.