Nursing Cost Analysis for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit

Objective: To determine nursing costs for intensive care unit (ICU) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), assess the correlation with diagnosis-related group (DRG) payments and identify cost determinants.

Design: Prospective, descriptive and quantitative study.

Methods: From January to December 2022, we selected ICU patients with AECOPD and used time-driven activity-based costing method to calculate the overall nursing costs. We examined the cost recovery rate, correlations between nursing costs and DRG Relative Weight, and factors influencing nursing costs using nonparametric tests, Spearman's rank correlation and quantile regression.

Results: The median nursing charge was US$1001.88, the median nursing cost was US$678.51, and the average cost recovery rate was 68.39%. Nursing costs correlated with the DRG Relative Weight but not with payments. Length of stay, oxygen therapy mode and noninvasive ventilator use days impacted costs.

Conclusions: Nursing costs exceeded charges, with a moderate cost recovery rate. DRG payments do not fully reflect nursing cost variations.

Relevance to clinical practice: Our findings indicate the need to enhance the reimbursement system for nursing costs and to manage ICU nursing expenses by addressing the determinants of these costs.

Reporting method: The authors adhered to the EQUATOR network guidelines STROBE to report observational cross-sectional studies.