Costing intensive care services: a review of study methods, results and limitations

Critical care services are an identified, resource-intensive component of health-care provision. Examining cost containment and clinical effectiveness in this specialty is therefore highly appropriate, although difficult to achieve in practice. The studies reviewed in this paper utilised various methodologies to capture different components of service and patient costs. The methods included combinations of per diem costs, hospital charges, direct consumption and unspecified cost estimates. Medical fees were commonly excluded and other costs, such as equipment and overheads, often not identified. Some more recent studies used clinical costing methods to capture individual patient-specific data, and demonstrated the feasibility and importance of these projects. Differing methods and data collection resulted in a limited comparative analysis, but issues requiring further research are highlighted. Funding of ICU services in Australia and nursing staff costs are also discussed. Future research will be aided by further sophistication in clinical information systems and the desire for clinicians to examine the link between costs and outcomes of the different activities pursued within the ICU.