ArticleJournal of intensive care2023
Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study.
Article in Journal of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Health Economic Evaluations in Intensive Care: An Updated Systematic Review.Critical care explorations · 2025Pooled it
- Socioeconomic and Regional Disparities in Long-Term Mortality Among Intensive Care Unit Survivors in South Korea: Nationwide Cohort Study.JMIR public health and surveillance · 2026Article
- Clinical Significance of Helicopter Transportation for Patients With Acute Illness Admitted to Medical Intensive Care Unit.Circulation reports · 2026Article
- Nationwide Comparison of ICU Procedure Frequencies in Japan Using a Public Open Database: A Cross-Sectional Study by ICU Admission Fee Type and Region.Journal of clinical medicine · 2026Article
- National cost of intensive care in Japan from 2018 to 2022.Journal of intensive care · 2026Article
- Prediction of financial deficits of postoperative patients in the intensive care unit using machine learning.JA clinical reports · 2025Article
- Closed intensive care units and sepsis patient outcomes: a secondary analysis of data from a multicenter prospective observational study in South Korea.Acute and critical care · 2025Article
- Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study.Critical care (London, England) · 2025Observational
- Cost-Effectiveness and Public Health Impact of Universal Prophylaxis with Nirsevimab Against Respiratory Syncytial Virus (RSV) Infections in all Infants in Japan.Infectious diseases and therapy · 2025Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundJapan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4.
methodsThis retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective.
resultsThe ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold.
conclusionsICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY.
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