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Tight Glycemic Control in Critically Ill Patients Translates Into Cost Savings

Posted: Thursday, April 20, 2006

Mean adjusted cost savings per patient was $1,580. In addition to the improvements in morbidity and mortality observed when ICU patients are maintained on intensive glycemia management protocols, health systems also benefit from substantially decreased costs.

Previous studies have documented 29% to 34% reductions in mortality, along with decreased rates of organ system dysfunction when critically ill patients are maintained in a euglycemic state. However, according to Dr. James Stephen Krinsley and Richard L. Jones, there have been no analyses of the cost of care associated with this intervention.

The researches therefore examined the costs incurred by patients treated in a 14-bed ICU that treated adult medical, surgical and cardiac patients at Stamford Hospital in Connecticut following institution of intensive glycemia management.

The baseline control group comprised 800 patients admitted consecutively to the ICU between February 2002 and January 2003, and the intervention group included the 800 patients admitted between February 2003 and January 2004. The intervention was a protocol to maintain blood glucose levels in the range of 80 to 140 mg/dL.

The ICU length of stay decreased from a median of 2.0 days during the baseline period to 1.7 days during the treatment period (p = 0.005). The total number of days on ventilation was reduced by 33.2% with intensive glycemic control.

The total laboratory and imaging costs fell significantly during the intervention. The total annualized adjusted total cost savings amounted to more than $1.3 million. Mean adjusted cost savings per patient was $1,580.

Cost savings were greatest for patients in the surgical, cardiac, and GI groups, and less so for those with septic shock and respiratory problems.

"Extension of these findings to large numbers of ICUs could have a major impact on national health-care expenditures," Dr. Krinsley and Jones write. "These findings provide further impetus for the emergence of tight glycemic control as a standard of care among the critically ill."

Source: Diabetes In Control: Chest 2006;129:644-650