OBJECTIVES:
1. Assess direct medical cost involved in management of diarrhea during ICU stay.
METHODS: Design: cross-sectional study; Site: Intensive care unit of a tertiary care hospital in south India; Duration: 3 months; Subjects: Patients who encountered diarrhea who met inclusion criteria (82 patients)
RESULTS:
Median investigational cost was ₹ 3240 IQR-6905 ($43.62). Median amount expended on medicines was ₹531.11 IQR-943.32. Diarrheal episodes can lead to an increase in ICU and or hospital stay. In this study, we found that mean cost for prolonged ICU stay was ₹6054.88 ±10494.56 and that of outside ICU was ₹987.80 ±1888.84. Therefore, mean cost of extended admissions was ₹7387.500 ± 12383.40($195.95), which is highest of all other costs. Median costs of wages for physician, nurses and basic salary workers were ₹8356.33 IQR- 3414.25, ₹3125 IQR 2397.12 and ₹1080 IQR-540 respectively. Other incidental costs included cost of materials used for cleaning purpose like under pad(₹780 IQR-420), cotton (₹300 IQR-300) and gloves(₹192.5 IQR 167.5) . Median incidental cost was ₹ 2643 IQR-1379.37 [$35.65]. We also observed that, our patients' disbursement for the management of Clostridium difficile caused diarrhea was the most. Elevation in the management cost was due to cost of antibiotics (vancomycin and metronidazole) administered against Clostridium difficile, furthermore, sigmoidoscopy used for detection of complications associated with Clostridium difficile also contributed to rise in marginal cost.
CONCLUSIONS:
Median total direct cost per episode of diarrhea in critical care unit patients was ₹ 8656.56 IQR – 19500.58 ($116.78), which is an approximate value of monthly wage of an average Indian family. Proper measures should be taken to prevent occurrence of diarrhea in critical care setting, which includes hygiene practices, avoiding irrational use of proton pump inhibitors and antibiotics. Large multi-center studies are needed to develop appropriate clinical protocols to prevent nosocomial diarrhea and its driven cost.
