title: Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients.
abstract: OBJECTIVE
  To estimate the actual cost savings that could be achieved through reductions in intensive care unit (ICU) length of stay and duration of mechanical ventilation by determining the short-run marginal variable cost of an ICU and ventilator day.
  
  
  METHODS
  Retrospective cohort study in a university-affiliated teaching hospital.
  
  
  METHODS
  All patients receiving mechanical ventilation in the ICU for more than 48 hours (n = 1778) from July 1, 2005 to June 30, 2006.
  
  
  METHODS
  The hospital's administrative and cost databases were used to determine total costs, variable costs, and direct-variable costs for each patient on each individual ICU and hospital day.
  
  
  RESULTS
  Direct-variable costs comprised 19.3% of total ICU costs and 18.4% of total hospital costs. Marginal direct-variable costs (the cost of each additional ICU day) were small compared with the average daily total cost ($649 to $839 vs. $1751, in US dollars). In survivors with ICU lengths of stay more than 3 days, the mean direct-variable cost of the last ICU day was $397, while the mean direct-variable cost of the first ward day was $279, for a mean cost difference of $118 (95% CI, $21-$190). Reducing ICU and hospital length of stay by 1 day in all survivors with ICU lengths of stay more than 3 days would result in an immediate cost savings of only 0.2% of all hospital expenditures for these patients.
  
  
  CONCLUSIONS
  Marginal variable ICU costs are relatively small compared with average total costs and are only slightly greater than the cost of a ward day.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. jmkahn@mail.med.upenn.edu
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Jeffery
authors.initials: J
authors.lastname: Rohrbach
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
mesh_terms: D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000191:economics*; D012189:Retrospective Studies