Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients

Med Care. 2008 Dec;46(12):1226-33. doi: 10.1097/MLR.0b013e31817d9342.


Objectives: 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.

Research design: Retrospective cohort study in a university-affiliated teaching hospital.

Subjects: All patients receiving mechanical ventilation in the ICU for more than 48 hours (n = 1778) from July 1, 2005 to June 30, 2006.

Measures: 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.

MeSH terms

  • Cohort Studies
  • Female
  • Hospital Costs
  • Hospitals, University / economics
  • Hospitals, University / organization & administration*
  • Humans
  • Intensive Care Units / economics*
  • Length of Stay / economics*
  • Male
  • Middle Aged
  • Respiration, Artificial / economics*
  • Retrospective Studies