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Context Severe acute pancreatitis is a common abdominal emergency; it is a potentially fulminant disease with no specific treatment. The incidence of severe acute pancreatitis is increasing, but the overall population mortality rate has remained unchanged as the case fatality rate has decreased over time. The hospital mortality rate of patients with severe acute pancreatitis has dropped to 20% even in the most severe forms of the disease. The prolonged course of severe acute pancreatitis, associated with multi-organ failure and other complications, is a considerable strain on intensive care unit (ICU) resources. Objective To analyze the extent of ICU resources consumed by the severe acute pancreatitis patient group as well as the expenses of the treatment and differences in the costs of survivors versus patients who die after a prolonged stay in the ICU. Design Retrospective study. Participants All patients with severe acute pancreatitis treated in the general ICU of Helsinki University Hospital from 1995 to 2005 (245 patients; 169 (69.0%) with alcoholinduced severe acute pancreatitis). Results The mean length of the ICU stay was 17.4 days and severe acute pancreatitis patients constituted 17.0% of all ICU days. The mean hospital cost per patient was 86,856 Euros. The overall mortality rate was 26.1% and the hospital costs of the non-survivors seemed to be higher (although not significantly) than that of the survivors. Conclusions Optimal early care in order to decrease the onset of organ dysfunctions and better prognostic models to identify nonsurviving severe acute pancreatitis patients earlier could lead to considerable savings in the overall use of ICU resources.