Cost of critical care in South Africa

Objective. To evaluate the cost of critical care in a respiratory intensive care unit (RICU). Design. A prospective cost-utility analysis of all admissions over a 4-week period. Setting. A 13-bed RICU admitting all categories of medical, surgical and trauma patients in a teaching hospital. Patients. All patients who were treated in the ICU over the 4-week period were included in the cost analysis. Outcome measures. The total cost of patient care, including all investigative and therapeutic modalities and medical, paramedical and ancillary staff salaries. Results. The total cost for the month was R549 705, including R197 222 for staff, R135 369 for special investigations, and R110 088 for intermittent positive-pressure ventilation and continuous positive airway pressure by face mask. The average daily cost per patient was R1 566, with conditions such as drug overdose, where supportive treatment only was needed, averaging R1 077 per patient per day compared with multiple injury from motor accidents, which cost R2 112 per patient per day. Increased severity of illness and ultimate death also significantly increased costs. Conclusion. Careful evaluation of the need for each high-cost item, particularly those used routinely, and each therapeutic intervention, and use of guidelines for drug therapy, special investigations and patient care, which help to improve both outcome and resource utilisation, may result in lower costs per survivor. In order to achieve optimum cost efficiency, an effective training programme in critical care incorporating experienced teachers from all disciplines, together with ongoing critical evaluation of the quality of care, are needed.