title: Is glycemic control of the critically ill cost-effective?
abstract: Intensive monitoring of blood glucose levels and treatment of hyperglycemia have been associated with significant improvements in morbidity and mortality in the critically ill. In contrast to the large prospective and observational body of data relating glycemic control and clinical outcomes, the financial impact of glycemic control implementation has not been as well described. This article details data from interventional trials of intensive insulin therapy; investigations that relate dysglycemia to morbidity, particularly intensive care unit (ICU)-acquired infections and increased ICU length of stay; and evaluations of the attributable cost of nosocomial infection in order to construct a sensitivity analysis of the net economic impact of glycemic control. It concludes that glycemic control is associated with positive financial outcomes, even using very conservative assumptions, and provides the reader with an automated spreadsheet to estimate the financial implications of glycemic control using assumptions based on locally derived data.
authors.affiliation: Director of Critical Care, Stamford Hospital, Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons, Stamford, CT. jkrinsley@stamhealth.org.
authors.forename: James S
authors.initials: JS
authors.lastname: Krinsley
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000191:economics; D038321:Glycemic Index; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000191:economics; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000191:economics / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin