Cost-Effectiveness in Critical Care: A Systematic Review of Empirical Evaluations

Background: Intensive Care Units (ICUs) provide essential therapies but are among the most resource-intensive areas of healthcare. Rising demand and escalating costs highlight the need for robust cost-effectiveness analyses (CEAs) to support efficient resource allocation. This review systematically synthesizes the available economic evaluations of ICU interventions and, where feasible, conducts meta-analyses to assess their value and inform policy, clinical decision-making, and future research. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines, registered in PROSPERO (CRD420251130870). Eligible studies were trial-based economic evaluations in adult ICU populations, reporting cost-effectiveness outcomes such as cost per life-year gained, life saved, or adverse event avoided. A comprehensive search was performed in PubMed, Scopus, and Web of Science, with data extracted independently by two reviewers. Costs were standardized to 2024 USD. Pooled estimates were synthesized using the Incremental Net Benefit (INB) framework. Results: From 5003 records, 15 trial-based economic evaluations met the inclusion criteria. Studies spanned diverse regions and ICU populations, assessing pharmacological, preventive, and organizational interventions. Reported ICERs ranged from $6904 to $69,346 per life-year gained and $51,664 to $476,499 per life saved, with several preventive and protocol-based strategies found to be dominant. Eight studies contributed to the meta-analysis, yielding a pooled INB of $15,123. Conclusions: This review highlights the wide variability in cost-effectiveness of ICU interventions, with preventive and quality-improvement strategies most often found to be economically dominant. Pharmacological and life-support therapies showed inconsistent value, underscoring the need for context-specific appraisal. Future evaluations should adopt standardized reporting and real-world data to better inform critical care policy and resource allocation.