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Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort
Claudia Dziegielewski1, Robert Talarico2, Haris Imsirovic2
1Department of Medicine, University of Ottawa, Ontario, Ottawa, Canada. cldziegielewski@toh.ca.
Insights
High-cost users in intensive care units (ICUs) have longer stays and higher costs, despite lower in-hospital mortality. Identifying these high-cost patients is key to reducing healthcare spending.
Area of Science:
- Healthcare Economics
- Critical Care Medicine
- Health Services Research
Background:
- Intensive care unit (ICU) healthcare expenditure represents a significant financial burden.
- Identifying high-cost users is a potential strategy for cost reduction in healthcare.
- Understanding the characteristics and outcomes of high-cost ICU patients is crucial for targeted interventions.
Purpose of the Study:
- To describe the characteristics of high-cost users admitted to the ICU.
- To analyze the health outcomes associated with high-cost ICU utilization.
- To investigate the cost patterns of high-cost users in the ICU.
Main Methods:
- A population-based retrospective cohort study was conducted using data from Ontario ICUs between 2011 and 2018.
- High-cost users were defined as those in the upper 10th percentile of total healthcare costs in the year following ICU admission.
- Patient characteristics, length of stay, mortality, disposition, and costs were compared between high-cost and non-high-cost user groups.
Main Results:
- The study included 370,061 patients, with 37,006 identified as high-cost users.
- High-cost users had longer ICU lengths of stay (22.4 days vs. 5.56 days) and higher total healthcare costs ($238,231 vs. $45,155).
- High-cost users exhibited lower in-hospital mortality (10.0% vs. 14.2%) but increased non-home disposition (77.4% vs. 42.2%).
Conclusions:
- High-cost users in the ICU are characterized by extended stays, lower in-hospital mortality, and substantially higher overall healthcare costs.
- These high-cost users accounted for a disproportionate 37.0% of total healthcare costs.
- Further research into cost patterns and predictors of high-cost ICU users is essential for developing effective cost-reduction strategies.
Background:
Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns.
Methods:
We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups.
Results:
Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0-22.7 days vs. 5.56 days, 95% CI 5.54-5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020-$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046-$45,264). High-cost users accounted for 37.0% of total healthcare costs.
Conclusion:
High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.
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