The Rising Cost of ICU Drugs

Introduction:

Introduction: The rising cost of pharmaceuticals is a global concern. In the United States, the overall expenditure on pharmaceuticals grew by 10.2% between 2023 and 2024 with a projected 9.0 – 11.0% rise in prescription drug spending by 2025. In the past, a significant proportion of drug cost is attributable to intensive care settings, accounting for an estimated 13.2% of hospital costs in 2010. Updated data within the past decade is sparce in the literature. The purpose of this study is to evaluate intensive care unit (ICU) drug expenditure trends compared to overall inpatient hospital drug costs over an 11-year period. A secondary purpose is to rank the top six most expensive ICU drugs based on average monthly cost.


Methods:

Methods: We conducted a retrospective review of drug expense data for our 24-bed mixed surgical / medical ICU during fiscal year (FY) 2012 – 2023. Drug expense data was retrieved from the hospital’s data repository and analyzed to calculated drug cost per ICU patient day, drug cost per ICU patient and percentage of ICU drug cost relative to total inpatient drug cost.


Results:

Results: The overall inpatient drug cost rose by 51% and ICU drug cost rose by 43% over the study period. Furthermore, the number of ICU patient days per year remained relatively unchanged over the study period, but the drug cost per ICU patient day rose steadily from $276 in FY 2012 to $620 in FY 2023; a 55% increase. Despite these increases, the percentage of ICU drug cost relative to the overall inpatient drug cost decreased from 9.5% to 8.1% over the same period. The top six most expensive ICU drugs based on average monthly cost were albumin, vasopressin, propofol, dexmedetomidine, treprostinil, and amphotericin-B liposome.


Conclusions:

Conclusion: The overall inpatient drug cost, ICU drug cost, and ICU drug cost per ICU patient day rose by 51%, 43%, and 55% respectively from FY 2012 - 2023. Despite these increases, the percentage of ICU drug cost relative the overall inpatient drug cost trended downward in the same period. This suggests that the increase in cost of non-ICU drugs outpaced that of ICU drugs to an extent that resulted in a net decrease in the percentage of ICU drug cost. Future studies should investigate the factors influencing this trend.