Objective: To determine the extent to which economic evaluations published in the Intensive Care Unit (ICU) literature provide information that could potentially improve the efficiency of critical care medicine.

Methods: We searched computerized bibliographic databases and manually searched key ICU journals to retrieve all economic evaluations dealing with relevant ICU problems, comparing competing alternative strategies. Included articles were appraised using methodologic and economic applicability criteria.

Results: We screened 4,167 papers manually and over 450 abstracts and titles in our computer search. 151 papers were further evaluated; 29 papers met inclusion criteria. Of 29, only 14 (48%) adequately described competing alternatives, 17 (59%) provided sufficient evidence of clinical efficacy, 6 (21%) identified, measured and valuated costs appropriately and 3 (10%) performed a sensitivity analysis. Overall, only 4 papers met a minimum level of methodologic soundness. Different costing structures and currency rates impaired the generalizability of these economic evaluations.

Discussion: Few economic evaluations in the ICU literature can be used to assist decision-makers in maximizing efficiency.