Intensive care use in a developing country: a comparison between a Tunisian and a French unit.
OBJECTIVE
To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions.


METHODS
Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals.


METHODS
Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs.


METHODS
We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups.


RESULTS
Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p < 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5%; p < 0.01) and received more treatment (p < 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p < 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients.


CONCLUSIONS
Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care.
Nouira
S
S
Service de Réanimation Médicale, Hôpital Universitaire de Monastir, Tunisia.
Roupie
E
E
El Atrouss
S
S
Durand-Zaleski
I
I
Brun-Buisson
C
C
Lemaire
F
F
Abroug
F
F
D000328:Adult; D000368:Aged; D019049:Developed Countries; D003906:Developing Countries; D003953:Diagnosis-Related Groups; D005260:Female; D005602:France; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D012720:Severity of Illness Index; D014416:Tunisia