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Preliminary Research on the Cost of ICUs inPuerto Rico (per diem)

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Main Documents:

The sources used inthis report were:

●      Referred toas Paper 1 in this report -- Dasta, Joseph F., McLaughlin, Trent P.,Mody, Samir H., Piech, Catherine Tak (2005). Critical Care Medicine 33,2005-06-01

●      Referred toas Paper 2 in this report -- Halpern, N. A., & Pastores, S. M.(2015). Critical Care Medicine Beds, Use, Occupancy, and Costs in the UnitedStates: A Methodological Review. Critical care medicine, 43(11),2452–2459. https://doi.org/10.1097/CCM.0000000000001227Re-imagina Report

●      Several otherAcademic papers. [i.e.“Potential costs of coronavirus treatment for people withemployer coverage”, The Peterson Center on Healthcare and KFF (Kaiser FamilyFoundation)]

Thisbrief report is meant to be a guide of the potential cost that a patient withCOVID-19 would confront in Puerto Rico. All the data used in this report is derivedfrom U.S. sources and as such, is likely higher than the costs confronted by aninpatient in Puerto Rico. Given, that the P.R. Institute of Statisticsestimates healthcare costs are notably lower in Puerto Rico than in the U.S.(around 20% to 30%), the costs presented below should be higher than the actualcosts in the Island.  

Costs of ICUs in the US (2005 – Paper 1)

Thefirst study reviewed in this report was published in 2002 using data from over250 US Hospitals. The estimated cost per patient in the ICU (Intensive CareUnit) are presented in the following table. Costs are split in threecategories, medical patients, surgical patients, and trauma patients.

Thestudy found that costs vary by the number of days spent in the ICU, the firsttwo days being much more expensive, then the costs flattened out from the thirdday onward. Costs are also divided by those needing Mechanical Ventilation (MV)and those that don’t require mechanical ventilators (Non-MV). The incrementalcost is simply the difference between these the cost of MV patients and Non-MVpatients. Under these parameters, assuming a medical patient with MV, a14-day stay in the ICU would cost $54,780.

Table 1 – Estimated cost of ICU per day in USA

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Costs of ICUs in the US (2015 - Paper 2)

Thesecond study highlighted in this brief report looks at the methodology used inestimating the cost associated with ICUs using the Russel Equation[1]. According to the report, in 2010 costs wereestimated at $4,300 as is detailed below. Although not presented in the report,the authors also detail that costs are not the same for everyday spent in theICU, they cite Critical Care Medicine 33, 2005-06-01, that costs arereduced after the first couple of days. Under these parameters, assuming amedical patient with MV, a 14-day stay in the ICU would cost $60,200.

“Ourrecent calculations using the Russell equation (1;21) demonstrate that ICUcosts per day in 2010 were $4,300 and CCM costs per year in 2010 were$108 billion (unpublished data). Nationally, in 2010, CCM accounted for 13.2%of hospital costs, 4.14% of National Heath Expenditures (NHE) and 0.74% of theUS GDP.”[2]

Estimated Costs of an ICU stay between 14 & 21 days in Puerto Rico

Basedon the studies presented earlier, ABEXUS, LLC then estimated the followingcosts for ICUs . Two scenarios are estimated, the first assumes that patientsspent 14 days in the ICU for medical reasons (not trauma nor surgery) on MV.The second scenario assumes patients spent 21 days in the ICU for medicalreasons (not trauma nor surgery) on MV. (industry sources indicate that aCOVID-19 patient could average between 15 to 24 days in an ICU)

*Thereader must consider that not all of COVID-19 patients are currently under ICU,in fact, the majority -depending on pre-existing conditions- could remain athome.

Theestimates are provided as costs per patient and costs per 20 patients.

1.      One patient- Costs range from $54,780 to $60,200 for a 14 day stay at the ICU usingmechanical ventilators.

2.     One patient- While for a 21 day stay costs range from $81,093 and $90,300.

3.    If thiscost were estimated for 20 patients, those staying 14 days would see a bill(most probably the insurance company) between $1 million and $1.2 million,while those staying 21 days would have estimated costs of $1.6 million to $1.8million.

*These estimates assume the patients had noother medical conditions and required no additional procedures.

Table 2 – Costs per patient and per20 patients

[1] Critical Care Medicine. Authormanuscript; available in PMC 2017 July 21. Page 5. “Congress published theHealth Technology Case Study on ICU Outcomes, Costs, and Decision making thatpopularized the “Russell Equation” for determining CCM costs. The Russellequation has since undergone several iterations, and today appears to be themost used national CCM costing methodology, arguably the gold standard”.

[2] Critical Care Medicine. Authormanuscript; available in PMC 2017 July 21. Page 6.

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