The healthcare costs of intoxicated patients who survive ICU admission are higher than non-intoxicated ICU patients: a retrospective study combining healthcare insurance data and data from a Dutch national quality registry

Abstract

BackgroundThe aim of this study was to describe the healthcare costs of intoxicated ICU patients in the year before and the year after ICU admission, and to compare their healthcare costs with non-intoxicated ICU patients and a population based control group.MethodsWe conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012 until 2014 were combined with the clinical data of patients who had been admitted to an ICU during 2013. Three study populations were compared and matched according to socioeconomic status, type of admission, age and gender: an “ICU population”, an “intoxication population” and a “control population” (who had never been on the ICU).Results2591 individual “intoxicated ICU patients” were compared to 2577 general “ICU patients” and 2591 patients from the “control population”. The median and interquartile ranges (IQR) healthcare costs per day alive for the “intoxicated ICU patients” were higher during the year before ICU admission (€20.3 (IQR €3.6–€76.4)) and the year after ICU admission (€23.9 (IQR €5.1–€82.4)) compared to the ICU population (€6.1 (IQR €0.9–€29.3) and €13.6 (IQR €3.3–€54.9) respectively) and a general control population (€1.1 (IQR €0.3–€4.6) and €1.1 (IQR €0.4–€4.9) respectively). The healthcare associated costs in intoxicated ICU patients were correlated with the number of chronic conditions present prior ICU admission (p < 0.0001).ConclusionsIntoxicated patients admitted to the ICU had in the year before and after ICU admission much higher median healthcare costs per day alive compared to other ICU patients and a general population control group. Healthcare costs are greatly influenced by the number of psychiatric and other chronic conditions of these intoxicated patients.Electronic supplementary materialThe online version of this article (10.1186/s12873-019-0224-7) contains supplementary material, which is available to authorized users.

Development of a risk prediction nomogram for disposition of acute toxic exposure patients to intensive care unit

“…The leading cause for ICU admission in the developed countries is continuous monitoring of vital functions for untimely interference for any deteriorating signs 6 . However, unnecessary ICU admissions exhaust the hospital care services and inadequately occupy the precious ICU beds 7 . Therefore, efforts are needed to define the most likely patients to benefit from ICU admission.…”

Incidence of Intoxication Events and Patient Outcomes in Taiwan: a Nationwide Population-based Observational Study

“…The most likely reason is the higher proportion of severe intoxication events or greater severity of intoxication in our population (5)(6)(7)(8)(9)(10)(11)(12)(13)(16)(17)(18). Our mean ICU stay (3 days) and hospital LOS (7 days) was longer than reported in studies from The Netherlands and Hong Kong (ICU: 0-1.3 days; hospital LOS: 1-3 days) (14,18,19). If we calculate the ratio between the number of patients receiving different in-hospital treatments to patients receiving mechanical ventilation, the ratio of the patients receiving inotropic agent to patients receiving mechanical ventilation was 0.848:1.…”

Incidence of intoxication events and patient outcomes in Taiwan: A nationwide population-based observational study

“…Our overall in-hospital mortality rate was much higher than reported in other countries (Taiwan: 2.6%, other countries: 0.1–1.3%), as was our mortality rate from severe intoxication (Taiwan: 21.6%, other countries: 2–9%) [ 3 , 4 , 25 , 26 ]. The most likely reason is the higher proportion of severe intoxication events or greater severity of intoxication in our population [ 16 – 24 , 27 – 29 ]. Our mean ICU stay (3 days) and hospital LOS (7 days) was longer than reported in studies from The Netherlands and Hong Kong (ICU: 0–1.3 days; hospital LOS: 1–3 days) [ 25 , 29 , 30 ].…”

“…The most likely reason is the higher proportion of severe intoxication events or greater severity of intoxication in our population [ 16 – 24 , 27 – 29 ]. Our mean ICU stay (3 days) and hospital LOS (7 days) was longer than reported in studies from The Netherlands and Hong Kong (ICU: 0–1.3 days; hospital LOS: 1–3 days) [ 25 , 29 , 30 ]. If we calculate the ratio between the number of patients receiving different in-hospital treatments to patients receiving mechanical ventilation, the ratio of the patients receiving inotropic agents to patients receiving mechanical ventilation was 0.848:1.…”