Costs of sepsis treatment between survivors and nonsurvivors in Brazilian ICUs: does it matter?

Introduction

Sepsis has been considered a major healthcare problem, upheld by the resources consumed to care for patients with this disease and its high incidence and associated mortality rate. Although we are aware of the high total hospital costs associated with sepsis treatment, even post discharge, the difference in costs of sepsis treatment between survivors and nonsurvivors is an economic analysis that can provide more reliable and interchangeable data. Literature addressing the costs of sepsis management is scant.

Objectives

To assess direct costs of sepsis treatment in Brazilian ICUs, comparing survivors and nonsurvivors until ICU discharge.

Design

An observational cohort study.

Setting

Twenty-one ICUs of private and public hospitals.

Patients and methods

Patients admitted with sepsis, severe sepsis or septic shock were enrolled to the study. During 6 months, patients meeting these criteria underwent clinical and epidemiological evaluation. Hospital costs related to ICU stay were also estimated. Standard values were based on the Brazilian Medical Association (AMB) price index for medical procedures and the BRASÍNDICE price index for medications, solutions and hospital materials. The concept of direct costs was established considering clinical support services (pharmacy, physiotherapy, radiology and laboratory service), consumables (drugs, fluids, nutrition, blood and blood products), and staff (medical staff, technicians and nursing staff). The Kruskal–Wallis test was performed to test for differences in the medians of cost among groups defined according to quartiles of length of stay or tertiles of SOFA score. Simultaneous multiple pair-wise comparisons among groups were performed with the Conover–Inman test. All hypothesis testing was two-tailed; P < 0.05 was considered statistically significant.

Measurements and main results

A total of 524 patients were enrolled. The mean age was 60.5 years and 58% were male. The overall mortality was 43.8% and the median SOFA score was 7.6. Considering the length of stay, survivors and nonsurvivors had similar (median 13 and 10, respectively, P = 0.097). Costs did not differ significantly ($9352 for survivors vs $9116 for nonsurvivors; P = 0.763). However when comparing costs between survivors and nonsurvivors, dividing the length of stay into quartiles, we found a statistically significant difference between both groups (P < 0.0001), even considering the SOFA score when divided into tertiles, mainly comparing SOFA survivors <7 (P < 0.05).

Conclusions

This century appears set to become the century of biotechnological advance in healthcare. Unfortunately, the general restrictions on resources make the introduction of new interventions difficult, even if it will not have any cost analysis. Our data reveal an expected reality, that we have differences in costs between survivors and nonsurvivors, mainly comparing length of stay. Moreover, we still have to access the specific areas that have more impact in these direct costs to apply strategies that should offer a better outcome in septic patients.