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Background: Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium.Methods This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital's point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor.Results The proportion of ICU beds to ward beds was a median [p25-p75] of 4.7% [4.4–5.9]. The proportion of indirect costs to total costs in the ICU was 12.1% [11.4–13.3]. The cost of nurses represented 57.2% [55.4–62.2] of direct costs and this was 15.9% [12.0-18.2] of the cost of nurses in the whole hospital. The median cost per stay was €4,267 [2,050–9,658] and was €2,160 [1,545–3,221] per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication.Conclusions This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results.

Background In view of the expected increase in expenditure on hip replacement treatment in Belgium [10], the complication rate [3] and the possible reduction in waste estimated by the OECD [1], we are not yet in a position to objectify the effectiveness of hip replacement treatment in Belgian hospitals. This objective study aims to propose a hospital comparison through the use of a cost-DALY ratio for hip replacement surgery among 12 Belgian hospitals. Methods In our study, the DALY calculation was applied at the hospital level for complications. Mortality was calculated on the basis of the Belgian mortality and life expectancy tables [15]. A DALY has been assigned to readmissions within 30 days. The costs of this study are the hospital costs of the PACHA hospital analysis. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model. Results We have 2,411 inpatients with an average age (Standard Deviation) of 69 years (13.5 years). The complication rate during hospital stays is estimated at 6.93% while the mortality rate is 1.20%. The average cost (SD) of a stay is €8,013 (€4,304). We have registered a total of 246.5 DALYs for the 12 hospital institutions in the study. Conclusion Other indicators should complete our study, including the patient's perception of the actual results experienced by the patient. Our analysis invites the authorities to create good practice guides for common diseases such as hip replacement surgery. Based on this first experience for the orthopaedic sector, we are convinced of the usefulness of our approach in evaluating the "cost-effectiveness" of other care systems.