Research Article
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Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review

Year 2025, Volume: 15 Issue: 2, 749 - 760, 30.05.2025

Abstract

Objective: Intensive care units are one of the most complex and critical service production areas that incur high levels of resource consumption in hospitals. This study aims to analyze the cost structures of intensive care units, and to examine cost containment strategies that can be implemented in this area.
Methods: The study is a systematic literature review, employing the PRISMA flow diagram. The review was carried out in two stages using the Web of Science database, focusing on the cost structures of units and cost reduction strategies.
Results: The study synthesized finding from 14 papers to examine the topic. The results of the 10 studies on the cost structure indicated that the cost structures of intensive care units are mostly composed of labor, medical consumables, and equipment expenses. Among the cost control methods, quality improvement, lean management, and value streams were detected to be frequently used approaches.
Conclusion: Given that intensive care units are high-cost service areas, it will be beneficial to examine them considering cost management approaches.

Project Number

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References

  • 1.Marshall JC, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J. Crit. Care 2017; 37:270-276. https://doi.org/10.1016/j.jcrc.2016.07.015.
  • 2.Christensen M, Liang M. Critical care: A concept analysis. Int J Nurs Sci 2023; 10:403-13.https://doi.org/10.1016/j.ijnss.2023.06.020.
  • 3. Intensive Care Society. What is intensive care? [Internet]. Available from: https://ics.ac.uk/about-icu/what-is-intensive-care.html
  • 4. OECD Statistics. Hospital beds [Internet]. Available from: https://data.oecd.org/healtheqt/hospital-beds.htm
  • 5. Weiner-Lastinger LM, et al. Changes in the number of intensive care unit beds in US hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022;43(10):1477-81. https://doi.org/10.1017/ice.2021.266.
  • 6. Halpern NA, Bettes L, Greenstein R. Federal and nationwide intensive care units and healthcare costs: 1986-1992. Crit Care Med 1994; 22:2001-7.
  • 7. Dasta JF, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005;33(6):1266-71. https://doi.org/10.1097/01.CCM.0000164543.14619.00
  • 8. Seidel J, Whiting PC, Edbrooke DL. The costs of intensive care. Cont Educ Anaesth Crit Care Pain 2006;6(4):160-3. https://doi.org/10.1093/bjaceaccp/mkl030.
  • 9. Aygencel G, Türkoglu M. Characteristics, outcomes and costs of prolonged stay ICU patients. J Crit Intensive Care 2011;2(3):53. https://doi.org/10.5152/dcbybd.2011.12.
  • 10. Lefrant JY, et al. The daily cost of ICU patients: a micro-costing study in 23 French intensive care units. Anaesth Crit Care Pain Med 2015;34(3):151-7. https://doi.org/10.1016/j.accpm.2014.09.004.
  • 11. Kılıç M, et al. Cost analysis on intensive care unit costs based on the length of stay. Turk J Anaesthesiol Reanim 2019;47(2):142. https://doi.org/10.5152/TJAR.2019.80445.
  • 12. Eren ÖÖ, et al. Factors affecting cost of patient care in intensive care unit. Selçuk Med J 2009; 25:195-202.
  • 13. Mastrogianni M, et al. Factors affecting adult intensive care units costs by using the bottom-up and top-down costing methodology in OECD countries: a systematic review. Intensive Crit Care Nurs 2021; 66:103080. https://doi.org/10.1016/j.iccn.2021.103080
  • 14. Dziegielewski C, et al. Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study. BMC Health Serv Res 2021; 21:1-10. https://doi.org/10.1186/s12913-021-07318-y
  • 15. Rodosthenous M, et al. Impact of Cost Accounting Models on Estimations in Adult Intensive Care Units (ICUs) and on Reimbursement System: A Case Study of a Public Hospital During the Covid-19 Pandemic. The Role of the Public Sector in Building Social and Economic Resilience: A Public Finance Approach. Cham: Springer Nature Switzerland, 2024. 313-337.
  • 16. Wilcox ME, et al. Cost-effectiveness studies in the ICU: a systematic review. Crit. Care Med. 2019;47(8):1011-1017. https://doi.org/10.1097/CCM.0000000000003768
  • 17. Chacko B, et al. Approach to intensive care costing and provision of cost-effective care. Indian J Crit Care Med 2023;27(12):876. https://doi.org/10.5005/jp-journals-10071-24576
  • 18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372. https://doi.org/10.1136/bmj.n71.
  • 19. Pranckutė R. Web of Science (WoS) and Scopus: The titans of bibliographic information in today’s academic world. Publications 2021;9(1):12. https://doi.org/10.3390/publications9010012
  • 20. Bergman EML. Finding citations to social work literature: The relative benefits of using Web of Science, Scopus, or Google Scholar.J Acad Librariansh 2012;38(6): 370-379. https://doi.org/10.1016/j.acalib.2012.08.002
  • 21. Tan SS, et al. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value in Health 2012;15(1):81-6. https://doi.org/10.1016/j.jval.2011.09.007.
  • 22. Haque A, et al. Cost of care in a paediatric intensive care unit of a tertiary-care university hospital of Pakistan. Trauma 2015;21(14).
  • 23. Van Diepen S, et al. Incremental costs of high intensive care utilisation in patients hospitalised with heart failure. Eur Heart J Acute Cardiovasc Care 2019;8(7):660-6. https://doi.org/10.1177/2048872619845282.
  • 24. Aung YN, et al. Determining the cost and length of stay at intensive care units and the factors influencing them in a teaching hospital in Malaysia. Value Health Reg Issues 2020; 21:149-56. https://doi.org/10.1016/j.vhri.2019.09.006.
  • 25. Singh T, Pillai J, Sahoo MC. How much does it cost for a surgical ICU bed in a public hospital in India. Risk Manag Healthc Policy 2021; 14:4149-54.
  • 26. Kaur A, et al. Baranwal AK. Cost analysis of pediatric intensive care: a low-middle income country perspective. BMC Health Serv Res 2021; 21:1-9. https://doi.org/10.1186/s12913-021-06166-0.
  • 27. Reddy KN, et al. Direct medical cost analysis of Indian COVID-19 patients requiring critical care admission. Indian J Crit Care Med 2021;25(10):1120. https://doi.org/10.5005/jp-journals-10071-23991.
  • 28. Bruyneel A, et al. Cost comparisons and factors related to cost per stay in intensive care units in Belgium. BMC Health Serv Res 2023;23(1):986. https://doi.org/10.1186/s12913-023-09926-2.
  • 29. Trzeciak S, et al. Lean Six Sigma to reduce intensive care unit length of stay and costs in prolonged mechanical ventilation. J Healthc Qual 2018;40(1):36-43. https://doi.org/10.1097/JHQ.0000000000000075.
  • 30. Ersson A, et al. Effects of a multifaceted intervention QI program to improve ICU performance. BMC Health Serv Res 2018; 18:1-11. https://doi.org/10.1186/s12913-018-3648-y.
  • 31. Serrano-Eanelli D, et al. Electronic medical orders for life-sustaining treatment in New York State: length of stay, direct costs in an ICU setting. Palliat Support Care 2019;17(5):584-9.
  • 32. Chung TH, et al. Palliative care consultation in the intensive care unit reduces hospital costs: a cost-analysis. J Palliat Care 2022. https://doi.org/10.1177/08258597221095986
  • 33. Walker KA, et al. Effectiveness of integration of palliative medicine specialist services into the intensive care unit of a community teaching hospital. J Palliat Med 2013;16(10):1237-41. https://doi.org/10.1089/jpm.2013.0052.
  • 34. Norton SA, et al. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007;35(6):1530-5. https://doi.org/10.1097/01.CCM.0000266533.06543.0C.
  • 35. Kyeremanteng K, et al. The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med 2018;33(6):346-53. https://doi.org/10.1177/0885066616664329.
  • 36. Wilcox ME, et al. Cost-effectiveness studies in the ICU: a systematic review. Crit Care Med 2019;47(8):1011-7. https://doi.org/10.1097/CCM.0000000000003768.
  • 37. Rahimi H, et al. Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran. Plos one 2023;18(5): e0285792. https://doi.org/10.1371/journal.pone.0285792
  • 38. Herzer KR, et al. Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA. BMJ open 2014;4(9): e006065.
  • 39. Khandelwal N, et al. Patterns of cost for patients dying in the intensive care unit and implications for cost savings of palliative care interventions. J Palliat Med 2016;19(11):1171-1178. https://doi.org/10.1089/jpm.2016.0133
  • 40. Kansal A, et al. Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Cri Care 2023;27(1):487. https://doi.org/10.1186/s13054-023-04766-2
  • 41. Van der Sluij, AF, et al. The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review. J Intensive Care 2017; 5:1-8. https://doi.org 10.1186/s40560-016-0207-7
  • 42. Wunsch H, et al. Economics of ICU organization and management. Crit care Clin 2012;28(1):25.

Yoğun Bakım Maliyetleri ve Efektif Maliyet Kontrol Yöntemleri: Bir Sistematik Literatür Çalışması

Year 2025, Volume: 15 Issue: 2, 749 - 760, 30.05.2025

Abstract

Amaç: Yoğun bakımlar yüksek kaynak tüketimleri ile birlikte hastanelerin en karmaşık ve kritik hizmet üretim alanlarından biridir. Bu çalışmada yoğun bakımların, maliyet yapıları bakımından analiz edilmesi ve bu alanda yapılabilecek maliyet düşürme çalışmalarının irdelenmesi amaçlanmıştır.
Yöntem: Sistematik literatür taraması yöntemi ile yürütülen çalışmada PRISMA akış diyagramı kullanılmıştır. Tarama yoğun bakımların maliyet yapıları ve maliyet azaltma çalışmaları şeklinde iki aşamada Web of Science veri tabanında gerçekleştirilmiştir.
Bulgular: Çalışma kapsamında 14 makalenin bulguları bir araya getirilerek konu irdelenmiştir. Maliye yapısı üzerine odaklanan 10 adet çalışmanın bulguları yoğun bakımların maliyet yapılarının yoğun olarak işçilik, tıbbi malzeme ve ekipman giderlerinden oluştuğunu göstermiştir. Maliyet kontrol yöntemleri arasında ise kalite iyileştirme, yalın, değer akışları gibi yöntemlerin yer aldığı görülmüştür.
Sonuç: Yoğun bakımların yüksek maliyetli üretim alanları olması sebebiyle, maliyet yönetimi yaklaşımları ile incelenmesinin faydalı olacağı görülmektedir.

Ethical Statement

Çalışma, sistematik bir tarama çalışması olması sebebiyle etik kurul izni gerektirmemektedir.

Supporting Institution

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Project Number

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Thanks

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References

  • 1.Marshall JC, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J. Crit. Care 2017; 37:270-276. https://doi.org/10.1016/j.jcrc.2016.07.015.
  • 2.Christensen M, Liang M. Critical care: A concept analysis. Int J Nurs Sci 2023; 10:403-13.https://doi.org/10.1016/j.ijnss.2023.06.020.
  • 3. Intensive Care Society. What is intensive care? [Internet]. Available from: https://ics.ac.uk/about-icu/what-is-intensive-care.html
  • 4. OECD Statistics. Hospital beds [Internet]. Available from: https://data.oecd.org/healtheqt/hospital-beds.htm
  • 5. Weiner-Lastinger LM, et al. Changes in the number of intensive care unit beds in US hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022;43(10):1477-81. https://doi.org/10.1017/ice.2021.266.
  • 6. Halpern NA, Bettes L, Greenstein R. Federal and nationwide intensive care units and healthcare costs: 1986-1992. Crit Care Med 1994; 22:2001-7.
  • 7. Dasta JF, et al. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005;33(6):1266-71. https://doi.org/10.1097/01.CCM.0000164543.14619.00
  • 8. Seidel J, Whiting PC, Edbrooke DL. The costs of intensive care. Cont Educ Anaesth Crit Care Pain 2006;6(4):160-3. https://doi.org/10.1093/bjaceaccp/mkl030.
  • 9. Aygencel G, Türkoglu M. Characteristics, outcomes and costs of prolonged stay ICU patients. J Crit Intensive Care 2011;2(3):53. https://doi.org/10.5152/dcbybd.2011.12.
  • 10. Lefrant JY, et al. The daily cost of ICU patients: a micro-costing study in 23 French intensive care units. Anaesth Crit Care Pain Med 2015;34(3):151-7. https://doi.org/10.1016/j.accpm.2014.09.004.
  • 11. Kılıç M, et al. Cost analysis on intensive care unit costs based on the length of stay. Turk J Anaesthesiol Reanim 2019;47(2):142. https://doi.org/10.5152/TJAR.2019.80445.
  • 12. Eren ÖÖ, et al. Factors affecting cost of patient care in intensive care unit. Selçuk Med J 2009; 25:195-202.
  • 13. Mastrogianni M, et al. Factors affecting adult intensive care units costs by using the bottom-up and top-down costing methodology in OECD countries: a systematic review. Intensive Crit Care Nurs 2021; 66:103080. https://doi.org/10.1016/j.iccn.2021.103080
  • 14. Dziegielewski C, et al. Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study. BMC Health Serv Res 2021; 21:1-10. https://doi.org/10.1186/s12913-021-07318-y
  • 15. Rodosthenous M, et al. Impact of Cost Accounting Models on Estimations in Adult Intensive Care Units (ICUs) and on Reimbursement System: A Case Study of a Public Hospital During the Covid-19 Pandemic. The Role of the Public Sector in Building Social and Economic Resilience: A Public Finance Approach. Cham: Springer Nature Switzerland, 2024. 313-337.
  • 16. Wilcox ME, et al. Cost-effectiveness studies in the ICU: a systematic review. Crit. Care Med. 2019;47(8):1011-1017. https://doi.org/10.1097/CCM.0000000000003768
  • 17. Chacko B, et al. Approach to intensive care costing and provision of cost-effective care. Indian J Crit Care Med 2023;27(12):876. https://doi.org/10.5005/jp-journals-10071-24576
  • 18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372. https://doi.org/10.1136/bmj.n71.
  • 19. Pranckutė R. Web of Science (WoS) and Scopus: The titans of bibliographic information in today’s academic world. Publications 2021;9(1):12. https://doi.org/10.3390/publications9010012
  • 20. Bergman EML. Finding citations to social work literature: The relative benefits of using Web of Science, Scopus, or Google Scholar.J Acad Librariansh 2012;38(6): 370-379. https://doi.org/10.1016/j.acalib.2012.08.002
  • 21. Tan SS, et al. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value in Health 2012;15(1):81-6. https://doi.org/10.1016/j.jval.2011.09.007.
  • 22. Haque A, et al. Cost of care in a paediatric intensive care unit of a tertiary-care university hospital of Pakistan. Trauma 2015;21(14).
  • 23. Van Diepen S, et al. Incremental costs of high intensive care utilisation in patients hospitalised with heart failure. Eur Heart J Acute Cardiovasc Care 2019;8(7):660-6. https://doi.org/10.1177/2048872619845282.
  • 24. Aung YN, et al. Determining the cost and length of stay at intensive care units and the factors influencing them in a teaching hospital in Malaysia. Value Health Reg Issues 2020; 21:149-56. https://doi.org/10.1016/j.vhri.2019.09.006.
  • 25. Singh T, Pillai J, Sahoo MC. How much does it cost for a surgical ICU bed in a public hospital in India. Risk Manag Healthc Policy 2021; 14:4149-54.
  • 26. Kaur A, et al. Baranwal AK. Cost analysis of pediatric intensive care: a low-middle income country perspective. BMC Health Serv Res 2021; 21:1-9. https://doi.org/10.1186/s12913-021-06166-0.
  • 27. Reddy KN, et al. Direct medical cost analysis of Indian COVID-19 patients requiring critical care admission. Indian J Crit Care Med 2021;25(10):1120. https://doi.org/10.5005/jp-journals-10071-23991.
  • 28. Bruyneel A, et al. Cost comparisons and factors related to cost per stay in intensive care units in Belgium. BMC Health Serv Res 2023;23(1):986. https://doi.org/10.1186/s12913-023-09926-2.
  • 29. Trzeciak S, et al. Lean Six Sigma to reduce intensive care unit length of stay and costs in prolonged mechanical ventilation. J Healthc Qual 2018;40(1):36-43. https://doi.org/10.1097/JHQ.0000000000000075.
  • 30. Ersson A, et al. Effects of a multifaceted intervention QI program to improve ICU performance. BMC Health Serv Res 2018; 18:1-11. https://doi.org/10.1186/s12913-018-3648-y.
  • 31. Serrano-Eanelli D, et al. Electronic medical orders for life-sustaining treatment in New York State: length of stay, direct costs in an ICU setting. Palliat Support Care 2019;17(5):584-9.
  • 32. Chung TH, et al. Palliative care consultation in the intensive care unit reduces hospital costs: a cost-analysis. J Palliat Care 2022. https://doi.org/10.1177/08258597221095986
  • 33. Walker KA, et al. Effectiveness of integration of palliative medicine specialist services into the intensive care unit of a community teaching hospital. J Palliat Med 2013;16(10):1237-41. https://doi.org/10.1089/jpm.2013.0052.
  • 34. Norton SA, et al. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007;35(6):1530-5. https://doi.org/10.1097/01.CCM.0000266533.06543.0C.
  • 35. Kyeremanteng K, et al. The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med 2018;33(6):346-53. https://doi.org/10.1177/0885066616664329.
  • 36. Wilcox ME, et al. Cost-effectiveness studies in the ICU: a systematic review. Crit Care Med 2019;47(8):1011-7. https://doi.org/10.1097/CCM.0000000000003768.
  • 37. Rahimi H, et al. Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran. Plos one 2023;18(5): e0285792. https://doi.org/10.1371/journal.pone.0285792
  • 38. Herzer KR, et al. Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA. BMJ open 2014;4(9): e006065.
  • 39. Khandelwal N, et al. Patterns of cost for patients dying in the intensive care unit and implications for cost savings of palliative care interventions. J Palliat Med 2016;19(11):1171-1178. https://doi.org/10.1089/jpm.2016.0133
  • 40. Kansal A, et al. Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Cri Care 2023;27(1):487. https://doi.org/10.1186/s13054-023-04766-2
  • 41. Van der Sluij, AF, et al. The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review. J Intensive Care 2017; 5:1-8. https://doi.org 10.1186/s40560-016-0207-7
  • 42. Wunsch H, et al. Economics of ICU organization and management. Crit care Clin 2012;28(1):25.
There are 42 citations in total.

Details

Primary Language English
Subjects Health Management
Journal Section Research Article
Authors

Doğancan Çavmak 0000-0002-3329-4573

Project Number -
Early Pub Date May 28, 2025
Publication Date May 30, 2025
Submission Date September 13, 2024
Acceptance Date March 13, 2025
Published in Issue Year 2025 Volume: 15 Issue: 2

Cite

APA Çavmak, D. (2025). Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi, 15(2), 749-760.
AMA Çavmak D. Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. May 2025;15(2):749-760.
Chicago Çavmak, Doğancan. “Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi 15, no. 2 (May 2025): 749-60.
EndNote Çavmak D (May 1, 2025) Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi 15 2 749–760.
IEEE D. Çavmak, “Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review”, Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi, vol. 15, no. 2, pp. 749–760, 2025.
ISNAD Çavmak, Doğancan. “Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi 15/2 (May 2025), 749-760.
JAMA Çavmak D. Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2025;15:749–760.
MLA Çavmak, Doğancan. “Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review”. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi Ve Folklorik Tıp Dergisi, vol. 15, no. 2, 2025, pp. 749-60.
Vancouver Çavmak D. Costs of Intensive Care Units and Effective Cost Containment Approaches: A Systematic Review. Mersin Üniversitesi Tıp Fakültesi Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2025;15(2):749-60.

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