Hospital costs in patients receiving prolonged mechanical ventilation: does age have an impact?

BACKGROUND: The aging of the population is one of the causes of the increase in healthcare costs in the past few decades. It is controversial whether chronological age alone should be used in making healthcare decisions.

OBJECTIVE: To determine the association between age and hospital costs in patients receiving mechanical ventilation (MV).

DESIGN: Prospective, observational study.

SETTING: Intensive care units at a teaching hospital.

PATIENTS: A total of 813 adults who received prolonged (> or =48 hrs) mechanical ventilation.

INTERVENTION: None.

MEASUREMENTS: Severity of illness, comorbidities, length of stay, hospital costs, and mortality. We evaluated the independent association of age with hospital costs using linear regression.

RESULTS: Mean (+/-sd) age of patients was 60.4 +/- 18.8 yrs. Median Acute Physiology Chronic Health Evaluation III score and probability of hospital death at intensive care unit admission were 64 and 0.31, respectively. Hospital mortality was 36%. Median total hospital costs and daily costs were $ 56,056 and $2,655 US dollars, respectively. Older age was associated with lower total hospital costs after controlling for sex, intensive care unit type, severity of illness, length of stay, insurance type, resuscitation status, and survival. Hospital costs were significantly less in older patients in all cost departments examined, except for respiratory care and intensive care unit room costs.

CONCLUSIONS: Daily and total hospital costs were lower in older patients. Decreased hospital resource use in older patients may be related to a preference for less aggressive care by older patients and their families or by healthcare providers.