Factors associated with cost of adverse events in the intensive care unit: an economic evaluation performed in Bogotá, Colombia

Abstract

Background The costs of adverse health events represent a significant burden of disease. Management of these adverse events also entails high costs to healthcare systems, reaching up to US$110 516.25 in some countries. The intensive care unit is a context where they occur most frequently, with some studies reporting rates as high as 50% of the population. It is of utmost importance to examine which aspects of the care process related to patients or the events themselves have the most significant impact on costs. The objective of this economic evaluation is to establish the clinical and healthcare factors that determine the cost of adverse events in the intensive care units of two university hospitals in Bogotá, Colombia.Methods We carried out an economic analysis study evaluating the clinical factors of patient care and institutions that have the most impact on the costs of adverse events. The population consisted of patients treated in the intensive care units of two university hospitals in Bogotá during 2019 and 2022. The outcome variable was the costs of adverse events, measured as direct costs through the perspective of the institutions providing health services. To estimate the direction and degree of association between clinical variables, adverse events and care with the costs of adverse events, a generalised linear regression gamma link function log was performed.Results A total of 369 patients were included, 232 men (62.9%) and 137 women (37.1%), with a median age of 63 years. The median APACHE II classification system score was 13 points, and the median Charlson comorbidity index was 5. Of the adverse events, 252 (68.29%) were passively reported, 223 (60.43%) were preventable and 267 events (72.36%) were non-serious. The events had a median cost of US$54.32 per patient, and the variables related to higher cost were overall hospital stay, stay until the event, Charlson comorbidity index, reporting system, severity, overall stay until the event, musculoskeletal major disease categories, and events related to safe care, pharmacovigilance and technovigilance.Conclusion This study was able to establish that overall hospital stay, Charlson index, reporting system and severity are positively related to the costs of adverse events. The factors that were found to be associated with lower costs were length of stay until the event, admission diagnosis related to the musculoskeletal system, and presenting an event related to safe care, pharmacovigilance and technovigilance.