The healthcare costs of intoxicated patients who survive ICU admission are higher than non-intoxicated ICU patients: a retrospective study combining healthcare insurance data and data from a Dutch national quality registry

Abstract

Background: The aim of this study was to describe the healthcare costs of intoxicated ICU patients in the year before and the year after ICU admission, and to compare their healthcare costs with non-intoxicated ICU patients and a population based control group. Methods: We conducted a retrospective cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012 until 2014 were combined with the clinical data of patients who had been admitted to an ICU during 2013. Three study populations were compared and matched according to socioeconomic status, type of admission, age and gender: an "ICU population", an "intoxication population" and a "control population" (who had never been on the ICU). Results: 2591 individual "intoxicated ICU patients" were compared to 2577 general "ICU patients" and 2591 patients from the "control population". The median and interquartile ranges (IQR) healthcare costs per day alive for the "intoxicated ICU patients" were higher during the year before ICU admission (€20.3 (IQR €3.6-€76.4)) and the year after ICU admission (€23.9 (IQR €5.1-€82.4)) compared to the ICU population (€6.1 (IQR €0.9-€29.3) and €13.6 (IQR €3.3-€54.9) respectively) and a general control population (€1.1 (IQR €0.3-€4.6) and €1.1 (IQR €0.4-€4.9) respectively). The healthcare associated costs in intoxicated ICU patients were correlated with the number of chronic conditions present prior ICU admission (p < 0.0001). Conclusions: Intoxicated patients admitted to the ICU had in the year before and after ICU admission much higher median healthcare costs per day alive compared to other ICU patients and a general population control group. Healthcare costs are greatly influenced by the number of psychiatric and other chronic conditions of these intoxicated patients.