Understanding Cost-Effectiveness in the ICU

Health care delivery in the United States and abroad has undergone tremendous growth over the last several decades. Accompanying this growth in the diagnostic and therapeutic armamentarium, the costs of health care have escalated out of proportion to the rest of the economy. This exuberant growth has engendered careful scrutiny of the practice of medicine with regard to both its effectiveness and its efficiency. The intensive care unit (ICU) has not been exempt from the quest for increased efficiency of health care delivery. This movement demands that physicians understand not only the effectiveness but also the cost of their interventions. Cost-effectiveness and cost-utility analyses have become critical evaluative tools in medicine. Explicit articulation of comparative cost-effectiveness is helpful in making choices about allocating limited resources in the setting of increasing competition for these resources. This article provides a primer for understanding the methods and applications of cost-effectiveness and cost-utility analyses in the ICU.