Outcome and cost of sepsis in intensive care units in Hungary

Introduction

Septic patients do not just have higher than average mortality, but the cost implications of their treatment are significant as well. In this study we report the incidence of sepsis among patients treated in intensive care units (ICU) in Hungary in 2001. We also describe and analyse the outcome and cost of ICU treatment of sepsis in Hungary.

Methods

Our study consisted of two parts. In Part 1, we collected data on nationwide incidence and mortality of sepsis cases treated in ICUs in Hungary in 2001. We used secondary data provided by the National Health System database ('GYOGYINFOK'). All patients were selected who complied with the following two criteria: the patient was treated in an ICU and at least one septic ICD-10 code was included in the diagnostic code list. In Part 2, we conducted cost data collection and analysis based on the Cost Block Method [1]. We selected a nonrandom sample of six intensive care units where cost data of 10 severe sepsis patients were collected consecutively from 15 August 2002 backwards. Inclusion criteria were as described in a sepsis definition paper [2]. In order to validate these data, the participating units performed a prospective observational data collection between 15 August and 14 September 2002. Resource consumption of clinical support services, consumables and cost of medical and nursing staff were collected on a daily basis.

Results

We identified 2659 admissions with a septicaemia diagnosis code to ICUs in 2001. Mortality was 42.7%; the average length of stay was 14.46 days (SD 17.44 days; median value 9) among patients diagnosed with sepsis. After the intensive treatment, patients remained treated in other inpatient units for a further 18.14 days on average (SD 18.05; median 12). Cost questionnaires based on 70 patients were returned, 60 with retrospective and 10 with prospective cost evaluation of severe sepsis. The average daily cost of sepsis was 101,737 HUF (412 €), higher on days 1–3 than later. The main cost drivers were consumables (42%), clinical support services (19%) and staff cost (18%).

Conclusion

The incidence and outcome of severe sepsis in Hungary is similar to international data. Compared with our previous study [3], the cost per patient-day of severe sepsis is over three times more (112 € vs 412 €) than that of average intensive care patients. In proportion to total cost, we spend much more on drugs and less on personnel.