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COST OF INTENSIVE CARE IN INDIA

Published online by Cambridge University Press:  09 September 2016

John Victor Peter ,
Kurien Thomas ,
Lakshmanan Jeyaseelan ,
Bijesh Yadav ,
Thomas Isiah Sudarsan ,
Jony Christina ,
Anna Revathi ,
K R John  and
Thambu David Sudarsanam
John Victor Peter
Affiliation:
Medical Intensive Care Unit, Christian Medical [email protected]
Kurien Thomas
Affiliation:
Department of Medicine, Pondicherry Institute of Medical Sciences (PIMS)
Lakshmanan Jeyaseelan
Affiliation:
Department of Biostatistics, Christian Medical College
Bijesh Yadav
Affiliation:
Department of Biostatistics, Christian Medical College
Thomas Isiah Sudarsan
Affiliation:
Medical Intensive Care Unit, Christian Medical College
Jony Christina
Affiliation:
Clinical Epidemiology Unit, Christian Medical College
Anna Revathi
Affiliation:
Clinical Epidemiology Unit, Christian Medical College
K R John
Affiliation:
SRM Medical College
Thambu David Sudarsanam
Affiliation:
Department of Medicine, Christian Medical College
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Abstract

Objectives: 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.

Keywords

Direct medical costIndirect costWillingness-to-payIntensive careHealth economics
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 32 , Issue 4 , 2016 , pp. 241 - 245
Copyright
Copyright © Cambridge University Press 2016 

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References

REFERENCES

1. Barie, PS, Ho, VP. The value of critical care. Surg Clin North Am. 2012;92:1445-1462.Google Scholar
2. Ward, NS, Levy, MM. Rationing and critical care medicine. Crit Care Med. 2007;35 (Suppl) S102-S105.CrossRefGoogle ScholarPubMed
3. Zilberberg, MD. Understanding cost-effectiveness in the ICU. Semin Respir Crit Care Med. 2010;31:13-18.Google Scholar
4. Hernu, R, Cour, M, de la Salle, S, Robert, D, Argaud, L. Cost awareness of physicians in intensive care units: A multicentric national study. Intensive Care Med. 2015;41:1402-1410.Google Scholar
5. Wilcox, ME, Rubenfeld, GD. Is critical care ready for an economic surrogate endpoint? Crit Care. 2015;19:248.CrossRefGoogle ScholarPubMed
6. Thomas, K, Peter, JV, Christina, J, et al. Cost-utility in medical intensive care patients (CUTIP): Rationalizing on-going care and timing of discharge from intensive care. Ann Am Thorac Soc. 2015;12:1058-1065.CrossRefGoogle Scholar
7. Mishra, D, Singh, HP. Kuppuswamy's socioeconomic status scale – a revision. Indian J Pediatr. 2003;70:273-274.CrossRefGoogle ScholarPubMed
8. Frew, EJ, Wolstenholme, JL, Whynes, DK. Comparing willingness-to-pay: Bidding game format versus open-ended and payment scale formats. Health Policy. 2004;68:289-98.CrossRefGoogle ScholarPubMed
9. Ryan, M. A comparison of stated preference methods for estimating monetary values. Health Econ. 2004;13:291-296.CrossRefGoogle ScholarPubMed
10. Cookson, R. Willingness to pay methods in health care: A skeptical view. Health Econ. 2003;12:891-894.Google Scholar
11. Institute for Quality and Efficiency in Health Care. Working paper cost estimation. https://www.iqwig.de/download/Working_Paper_Cost_Estimation.pdf (accessed January 12, 2016).Google Scholar
12. Wee, HL, Machin, D, Loke, WC, et al. Assessing differences in utility scores: A comparison of four widely used preference-based instruments. Value Health. 2007;10:256-265.Google Scholar
13. Robinson, R. Cost-utility analysis. BMJ. 1993;307:859-862.Google Scholar
14. Garza, AG, Wyrwich, KW. Health utility measures and the standard gamble. Acad Emerg Med. 2003;10:360-363.Google Scholar
15. Divatia, JV. Caring for the critically ill in developing countries: A perspective from India. Rev Bras Ter Intensiva. 2015;27:7-9.Google Scholar
16. Shweta, K, Kumar, S, Gupta, AK, Jindal, SK, Kumar, A. Economic analysis of costs associated with a respiratory intensive care unit in a tertiary care teaching hospital in Northern India. Indian J Crit Care Med. 2013;17:76-81.Google Scholar
17. Kulkarani, AP, Divatia, JV. A prospective audit of costs of intensive care in cancer patients in India. Indian J Crit Care Med. 2013;17:292-297.Google Scholar
18. Parikh, CR, Karnad, DR. Quality, cost, and outcome of intensive care in a public hospital in Bombay, India. Crit Care Med. 1999;27: 1754-1759.Google Scholar
19. Prinja, S, Manchanda, N, Mohan, P, et al. Cost of neonatal intensive care delivered through district level public hospitals in India. Indian Pediatr. 2013;50:839-846.Google Scholar
20. Ahuja, RB, Goswami, P. Cost of providing inpatient burn care in a tertiary, teaching hospital of North India. Burns. 2013;39:558-564.CrossRefGoogle Scholar