<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec><h3>Introduction</h3>
<p>Using a plan to limit non-beneficial life support interventions has significantly reduced harm and loss of dignity for patients at the end of life. The association of these limitations with patients’ clinical characteristics and health care costs in the intensive care unit (ICU) needs further scientific evidence.</p>
</sec>
<sec><h3>Aim of the study</h3>
<p>To explore decisions to limit non-beneficial life support interventions, their correlation with patients’ clinical data, and their effect on the cost of care in the ICU.</p>
</sec>
<sec><h3>Material and Methods</h3>
<p>We included all patients admitted to the general ICU of a hospital in Greece in a two-year (2019–2021) prospective study. Data collection included patient demographic and clinical variables, data related to decisions to limit (withholding, withdrawing) non-beneficial interventions (NBIs), and economic data. Comparisons were made between patients with and without limitation decisions.</p>
</sec>
<sec><h3>Results</h3>
<p>NBIs were limited in 164 of 454 patients (36.12%). Patients with limitation decisions were associated with older age (70y vs. 62y; p&lt;0,001), greater disease severity score (APACHE IV, 71 vs. 50; p&lt;0,001), longer length of stay (7d vs. 4.5d; p&lt;0,001), and worse prognosis of death (APACHE IV PDR, 48.9 vs. 17.35; p&lt;0,001). All cost categories and total cost per patient were also higher than the patient without limitation of NBIs (9247,79€ vs. 8029,46€, p&lt;0,004). The mean daily cost has not differed between the groups (831,24€ vs. 832,59€; p&lt;0,716). However, in the group of patients with limitations, all cost categories, including the average daily cost (767.31€ vs. 649.12€) after the limitation of NBIs, were reduced to a statistically significant degree (p&lt;0.001).</p>
</sec>
<sec><h3>Conclusions</h3>
<p>Limiting NBIs in the ICU reduces healthcare costs and may lead to better management of ICU resource use.</p>
</sec>
</abstract>

Introduction
Using a plan to limit non-beneficial life support interventions has significantly reduced harm and loss of dignity for patients at the end of life. The association of these limitations with patients’ clinical characteristics and health care costs in the intensive care unit (ICU) needs further scientific evidence.

Aim of the study
To explore decisions to limit non-beneficial life support interventions, their correlation with patients’ clinical data, and their effect on the cost of care in the ICU.

Material and Methods
We included all patients admitted to the general ICU of a hospital in Greece in a two-year (2019–2021) prospective study. Data collection included patient demographic and clinical variables, data related to decisions to limit (withholding, withdrawing) non-beneficial interventions (NBIs), and economic data. Comparisons were made between patients with and without limitation decisions.

Results
NBIs were limited in 164 of 454 patients (36.12%). Patients with limitation decisions were associated with older age (70y vs. 62y; p<0,001), greater disease severity score (APACHE IV, 71 vs. 50; p<0,001), longer length of stay (7d vs. 4.5d; p<0,001), and worse prognosis of death (APACHE IV PDR, 48.9 vs. 17.35; p<0,001). All cost categories and total cost per patient were also higher than the patient without limitation of NBIs (9247,79€ vs. 8029,46€, p<0,004). The mean daily cost has not differed between the groups (831,24€ vs. 832,59€; p<0,716). However, in the group of patients with limitations, all cost categories, including the average daily cost (767.31€ vs. 649.12€) after the limitation of NBIs, were reduced to a statistically significant degree (p<0.001).

Conclusions
Limiting NBIs in the ICU reduces healthcare costs and may lead to better management of ICU resource use.

Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs

Medical School, Democritus University of Thrace

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction
Using a plan to limit non-beneficial life support interventions has significantly reduced harm and loss of dignity for patients at the end of...

Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs

Article Category: Research Article

Published Online: Nov 14, 2023

Page range: 230 - 238

Received: May 29, 2023

Accepted: Sep 30, 2023

DOI: https://doi.org/10.2478/jccm-2023-0028

Keywords
non-beneficial interventions, end-of-life, cost of care, intensive care units

© 2023 Sotiria Koutsouki et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Limitation of Non-Beneficial Interventions and their Impact on the Intensive Care Unit Costs

Article Category: Research Article

Published Online: Nov 14, 2023

Page range: 230 - 238

Received: May 29, 2023

Accepted: Sep 30, 2023

DOI: https://doi.org/10.2478/jccm-2023-0028

Keywordsnon-beneficial interventions, end-of-life, cost of care, intensive care units

© 2023 Sotiria Koutsouki et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
non-beneficial interventions, end-of-life, cost of care, intensive care units