Cost of Critically Ill Surgical Patients in Thailand: A Prospective Analysis of a Multicenter THAI-SICU Study
Sunisa Chatmongkolchart MD*1, Kaweesak Chittawatanarat MD, PhD*2, Osaree Akaraborworn MD, MSc*3, Chanatthee Kitsiripant MD*1, the THAI-SICU study group
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand *2 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand *3 Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Objective : To quantify the total cost per admission and daily cost of critically ill surgical patients and cost attributable to Acute
Physiologic Assessment and Chronic Health Evaluation (APACHE) II score, invasive mechanical ventilation and major
complications in surgical intensive care unit (SICU) including sepsis, acute respiratory distress syndrome (ARDS), acute
lung injury (ALI), acute kidney injury (AKI), cardiac arrest, and myocardial infarction.
Material and Method: A multicentre, prospective, observational, cost analysis study was carried out in SICU of five
university hospitals in Thailand. Patients of age over 18 admitted to SICU (more than 6 hours) from 18 April 2011 to 30
November 2012 were recruited.The total SICU cost per admission (in Thai baht currency year 2011-2012) were recorded
using hospital accounting database. Average daily SICU cost was calculated from total ICU cost divided by the ICU length
of stay.The occurrence of sepsis, major cardiac and respiratory complications and duration of invasive mechanical ventila-
tion were studied.
Results : A total of 3,055 patients with 12,592 ICU-days admitted to SICU during the study period. The median (IQR)
ICU- length of stay was 2 (1, 4) days. The median (IQR) total SICU cost per admission was 44,055 (29,950-73,694) Thai
baht. The median (IQR) daily cost was 18,777 (13,650-22,790) Thai baht. There was a variation of total and daily SICU cost
across ICUs. For each of APACHE II score increases, cost increases with a median (IQR) of 1,731.755 (1,507.418-
1,956.093) Thai baht. Invasive mechanically ventilated patients had higher cost than non-ventilated patients with a median
(IQR) 15,873.4 (15,631.13-16,115.67) Thai baht. The patient with any complications listed here (sepsis, ARDS, ALI, AKI,
myocardial infarction) had higher costs of care than ones who had none.
Conclusion : Cost of critically ill surgical patients in the public university hospital in Thailand was varied. The complications
occurred in ICU increased the cost. To quantify the resource consumption of individual patient admitted to SICU, the costing
method and cost components must be verified.
Keywords : Expenditure, Charge, Cost, Surgical intensive care, Critically ill surgical patient, University hospital
