Economies of scale in British intensive care units and combined intensive care/high dependency units

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Abstract
Objective To estimate the relationship between size of intensive care unit and combined intensive care/high dependency units and average costs per patient day. Design Retrospective data analysis. Multiple regression of average costs on critical care unit size, controlling for teaching status, type of unit, occupancy rate and average length of stay. Setting Seventy-two United Kingdom adult intensive care and combined intensive care/high dependency units submitting expenditure data for the financial year 2000–2001 as part of the Critical Care National Cost Block Programme. Interventions None. Measurements and results The main outcome measures were total cost per patient day and the following components: staffing cost, consumables cost and clinical support services costs. Nursing Whole Time Equivalents per patient day were recorded. The unit size variable has a negative and statistically significant (p<0.05) coefficient in regressions for total, staffing and consumables cost. The predicted average cost for a seven-bed unit is about 96% of that predicted for a six-bed critical care unit. Conclusion Policy makers should consider the possibility of economies of scale in planning intensive care and combined intensive care/high dependency units.