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OBJECTIVE: To evaluate the cost-effectiveness of de novo simvastatin plus standard therapy versus standard therapy alone in patients with sepsis during a 1-year period. METHODS: A total of 145 critically ill patients were recruited in an open-label, randomized, con- trolled clinical trial. Of these, 80 patients received standard therapy according to Surviving Sepsis Campaign Guidelines 2012, and 65 received oral simvastatin plus standard therapy. The outcomes assessed include survival at the end of 1-year follow-up and intensive care unit (ICU) length of stay. Per protocol analysis was used. RESULTS: The ICU length of stay was significantly decreased in the simvastatin group (P = .001). At 1 year, 46% of patients in the simvastatin group survived compared with 35% in the standard therapy group, although this was not significant (P = .173). However, a Kaplan-Meier curve showed a significant difference that favored the standard arm (P = .01). Simvastatin was the dominant treatment option based on lower total direct costs versus the standard group. Savings related to ICU length of stay was the main determinant of the cost-saving results of simvastatin. Incremental cost-effectiveness ratio was negative and thus was not calculated. Probabilistic sensitivity and one-way sensitivity analyses were done, and results were robust to change. CONCLUSION: de novo simvastatin as an adjunct to standard therapy in ICU patients with sepsis lowered the overall cost by shortening ICU length of stay and its associated costs, but generalization to patients with different magnitudes of sepsis severity and to different ethnic groups requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction  Intensive Care Unit (ICU) is a resource intense area consuming a vast majority of the hospital's budget. This study aimed to determine the costs of providing critical care to non-survivors in an adult ICU at a tertiary care teaching hospital in the Caribbean. Methods  A chart review of non-survivors over a period of nine months was done in an adult ICU. Admission diagnoses, Simplified Acute Physiology Score (SAPS II) score, daily laboratory investigations, drugs, and all therapeutic interventions including mechanical ventilation were recorded. Activity-based costs were prospectively estimated by data obtained from ICU flowsheets, nursing-activity scores, and various hospital departments. Results A total of 316 days of ICU intervention data were collected from the 39 non-survivors enrolled. The median patient age was 56 years. The median ICU length of stay (LOS) and the median duration of mechanical ventilation were five days. The median SAPS II score was 62. One-third of patients had cardiovascular problems and 28% were surgical patients. The total cost of providing ICU care for the non-survivors was US$ 765,233 with an average cost of US$ 19,621 per patient. Human resources (39%) and consumables (29%) were the highest components of costs. Patients who had a cardiac arrest before admission consumed more resources. A higher SAPS II score predicted a shorter LOS (p=0.01) and lower costs (p=0.03). Conclusions  ICU care for non-survivors consume significantly high resources. Stringent admission protocols and consideration of medical futility at an earlier stage, using prognostic models and clinical criteria may prevent unnecessary interventions and costs., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Gosula et al.)

The impact of mechanical ventilation on the daily costs of intensive care unit (ICU) care is largely unknown. We thus conducted a systematic search for studies measuring the daily costs of ICU stays for general populations of adults (age ≥18 years) and the added costs of mechanical ventilation. The relative increase in the daily costs was estimated using random effects meta regression. The results of the analyses were applied to a recent study calculating the excess length-of-stay associated with ICU-acquired (ventilator-associated) pneumonia, a major complication of mechanical ventilation. The search identified five eligible studies including a total of 54 766 patients and ~238 037 patient days in the ICU. Overall, mechanical ventilation was associated with a 25.8% (95% CI 4.7%-51.2%) increase in the daily costs of ICU care. A combination of these estimates with standardised unit costs results in approximate daily costs of a single ventilated ICU day of €1654 and €1580 in France and Germany, respectively. Mechanical ventilation is a major driver of ICU costs and should be taken into account when measuring the financial burden of adverse events in ICU settings.