In the face of large-scale healthcare crises, intensive care units (ICUs) must quickly expand their capacity to meet surging demand. Traditional responses—such as increasing bed numbers or reallocating resources—are often hampered by a fundamental limitation: the availability of trained personnel. Lengthy, resource-intensive medical training pathways cannot produce ICU-ready professionals fast enough during emergencies. To overcome this constraint, the European Society of Intensive Care Medicine (ESICM) launched C19_SPACE, a continent-wide initiative aimed at rapidly upskilling non-ICU professionals for deployment in critical care settings. This large-scale training programme was assessed through a detailed economic evaluation to determine its cost-effectiveness, return on investment (ROI) and contribution to system resilience.
A Structured Economic Evaluation Framework
The C19_SPACE programme was evaluated using a three-phase economic framework. First, a cost analysis accounted for both direct expenditures—such as materials, coordination and personnel—and indirect opportunity costs, particularly the time healthcare professionals spent in training instead of clinical duties. The total cost was €20.1 million, equating to €1146 per participant and €1659 per Quality-Adjusted Healthcare Worker (QAHW), defined as one achieving at least 80% proficiency in ICU-relevant skills.
Next, a cost-effectiveness analysis used the QAHW metric to approximate value in the absence of direct clinical outcome data. With 12,086 participants reaching the competency threshold, the programme demonstrated an efficient cost-to-impact ratio. The final phase calculated the ROI using both deterministic scenarios and probabilistic simulations. The deterministic model showed a base case ROI of 478%, with costs recovered within 5.1 days. Even under pessimistic assumptions, the investment was recouped in just over a month.
Modelling ROI in Crisis Conditions
Capacity expansion was a central feature of the model. The analysis focused on nursing availability, the principal limiting factor in ICU scalability. Based on estimated working hours and standard bed-to-nurse ratios, the programme enabled staffing for over 2500 additional ICU beds, accommodating roughly 9281 patients monthly. Assuming a standard value of €12,500 per ICU patient, this translated to a monthly economic value of €116 million.
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The deterministic scenario analysis explored best, probable and worst-case conditions. In the best-case scenario—assuming high bed utilisation, shorter ICU stays and more patients per nurse—the break-even point was reached in 1.4 days. Even in the least favourable scenario, with long ICU stays and lower utilisation, financial recovery occurred within 33 days. To account for uncertainty, a Monte Carlo simulation with 10,000 iterations produced a mean ROI of 455%, with 90% of outcomes falling between 130% and 1029%. The average break-even point across these simulations was 5.4 days.
Implications for Health System Resilience
The analysis underscores the value of proactive workforce planning. In contrast to traditional crisis responses centred on physical infrastructure, the C19_SPACE initiative placed the healthcare workforce at the heart of preparedness. By training nearly 17,500 professionals—including over 9000 nurses and 8000 doctors—the programme demonstrated how human capital investment can yield immediate and measurable returns.
Key to this success was the programme's scale and centralised design. Standardised digital content and local practical sessions reduced logistical costs and improved access. Furthermore, the inclusion of opportunity costs—representing 77% of total expenditure—highlighted the real societal investment involved in training. These costs, often overlooked, are vital for understanding the full economic picture.
The conservative modelling choices, such as focusing only on nursing impact and using short-term time horizons, ensured that benefits were not overstated. Even under minimal productivity assumptions, the training proved cost-effective. Although the study did not include direct patient outcome data, it provides strong financial justification for including rapid workforce development in crisis planning strategies.
The C19_SPACE programme offers compelling evidence that large-scale, crisis-driven workforce training is an economically sound and strategically vital investment. With high ROI, rapid cost recovery and significant increases in ICU capacity, such initiatives strengthen healthcare system resilience under pressure. Future research should investigate the long-term retention of skills and direct impacts on patient outcomes, but the immediate economic case for emergency upskilling is clear. By placing human capital at the centre of crisis response, healthcare systems can not only respond more effectively but also do so with financial prudence.
Source: Intensive Care Medicine
Image Credit: iStock
