Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study

Background Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). Methods We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. Results Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (<euro>330 [170; 620]) was significantly higher than the real cost (<euro>178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (<euro>40 [15; 100] vs. <euro>1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (<euro>65 [30; 120] vs. <euro>106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). Conclusion French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.