Costs of the COPD. Differences between intensive care unit and respiratory intermediate care unit.
BACKGROUND
To assess whether respiratory intermediate care units (RICUs) are cost effective alternatives to intensive care units (ICUs) for patients with exacerbation of chronic obstructive pulmonary disease (COPD).


METHODS
Multi-centre, prospective, bottom-up cost study performed in 15 ICUs and 6 RICUs. COPD patients staying longer than 48 h were recruited; those coming from other ICUs/RICUs, with immune-deficiency or stroke, were excluded. After the ICU sample was standardised to the RICU distribution of the reason-for-admission and infusion of a vasoactive drug on admission, 60 ICU patients and 65 RICU patients remained, of the original 164 recruited. For each patient, besides clinical data on admission and discharge, daily information about the resources consumed were recorded and analysed in terms of their costs.


RESULTS
Total cost per patient was lower in RICUs than in ICUs (754 vs. 1507 Euro; P < 0.0001). In all items, except drugs and nutrition, we found a significant lower cost in RICUs. Dead patients were noticeably different in terms of disease severity between ICUs and RICUs, while surviving ones were not.


CONCLUSIONS
Our study suggests that some COPD patients, less severe and with pure respiratory failure, could be successfully and less costly treated in RICUs.
Bertolini
Guido
G
GiViTI Coordinating Centre, Istituto di Ricerche Farmacologiche Mario Negri: Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò-24020 Ranica, Bergamo, Italy. bertolini@marionegri.it
Confalonieri
Marco
M
Rossi
Carlotta
C
Rossi
Giancarlo
G
Simini
Bruno
B
Gorini
Massimo
M
Corrado
Antonio
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003422:Critical Care / Q000191:economics*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics* / Q000628:therapy; D012124:Respiratory Care Units / Q000191:economics*; D012138:Respiratory Therapy / Q000191:economics*