COST OF INTENSIVE CARE IN INDIA.
OBJECTIVE
The majority of patients in India access private sector providers for curative medical services. However, there is scanty information on the cost of treatment of critically ill patients in this setting. The study evaluates the cost and extent of financial subsidy required for patients admitted to an intensive care unit (ICU) in India.


METHODS
Data on direct medical, direct nonmedical, and indirect cost were prospectively collected from critically ill patients admitted to a tertiary teaching hospital in India. Willingness-to-pay (WTP) amount was obtained from the next-of-kin following admission and the actual cost paid by the family at discharge was recorded.


RESULTS
The main diagnoses (n = 499) were infection (26 percent) and poisoning (21 percent). The mean APACHE-II score was 13.9 (95 percent confidence interval [CI], 13.3-14.5); 86 percent were ventilated. ICU stay was 7.8 days (95 percent CI, 7.3-8.3). Hospital mortality was 27.9 percent. Direct medical cost accounted for 77 percent (US$ 2164) of the total treatment cost (US$ 2818). Indirect cost and direct nonmedical cost contributed to 19 percent (US$ 547.5) and 4 percent (US$ 106.5), respectively. Average total and daily ICU cost were US$ 1,897 and US$ 255, respectively. Although the family's WTP was 53 percent (US$ 1146; 95 percent CI, 1090-1204) of direct medical cost, their final contribution was 67.7 percent (US$ 1465; 95 percent CI, 1327-1604).


CONCLUSIONS
The cost of an ICU admission in our setting is US$ 2818. Although the family's contribution to expenses exceeded their initial WTP, a substantial subsidy (33 percent) is still required. Alternate financing strategies for the poor and optimization of ICU resources are urgently required.
Medical Intensive Care Unit,Christian Medical Collegepeterjohnvictor@yahoo.com.au.
John Victor
JV
Peter
Department of Medicine,Pondicherry Institute of Medical Sciences (PIMS).
Kurien
K
Thomas
Department of Biostatistics,Christian Medical College.
Lakshmanan
L
Jeyaseelan
Department of Biostatistics,Christian Medical College.
Bijesh
B
Yadav
Medical Intensive Care Unit,Christian Medical College.
Thomas Isiah
TI
Sudarsan
Clinical Epidemiology Unit,Christian Medical College.
Jony
J
Christina
Clinical Epidemiology Unit,Christian Medical College.
Anna
A
Revathi
SRM Medical College.
K R
KR
John
Department of Medicine,Christian Medical College.
Thambu David
TD
Sudarsanam
D018806:APACHE; D000328:Adult; D003365:Costs and Cost Analysis; D016638:Critical Illness / Q000191:economics*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D016304:Hospitals, Private / Q000191:economics*; D006801:Humans; D007194:India; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
Direct medical cost; Health economics; Indirect cost; Intensive care; Willingness-to-pay