What are the direct costs of sepsis treatment in Brazilian ICUs?

Introduction

Severe sepsis and septic shock are characterized by a high incidence, mortality and cost. Actually, sepsis is a major healthcare problem, upheld by the resources consumed to care for patients with this disease. Although we are aware of the high total hospital costs associated with sepsis treatment, even post discharge, the heterogeneity of the health care system (private or public hospitals) makes any estimate of costs directly attributable to sepsis a real challenge. Besides direct and indirect costs, 'hidden costs' like education, staff training and comorbidity-related issues can be significant in a major disease. Direct costs are defined mainly by the physicians and nursing fees, medicines, blood products and equipments used for monitoring and organ dysfunction support in sepsis. This simplified type of economic analysis can provide more reliable and interchangeable data.

Objective

To assess the direct costs of sepsis treatment in Brazilian ICUs, comparing private and public hospitals.

Design

An observational cohort study.

Setting

Twenty-one ICUs of private and public hospitals.

Patients

Patients admitted to one of the ICUs with sepsis, severe sepsis or septic shock, according to SCCM/ACCP Consensus Conference criteria, were enrolled to the study. During 6 months (1 October 2003 to 30 March 2004) the collected data were analyzed. Patients meeting these criteria underwent clinical and epidemiological evaluation. Hospital costs related to ICU stay were also estimated. Indirect cost estimates like administrative issues, electrical energy, depressed state of the equipment and facility maintenance were not included in the economic analysis. The TISS (Simplified Therapeutic Intervention Scoring System) score was also used for cost estimation. To compare the groups (public and private) we used the Mann–Whitney test and the Student t test. 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.

Measurements and main results

For the 619 patients included, only 85% were enrolled, considering 37.6% from private institutions and 62.4% from public institutions. From these data, 58% were male, the mean age was 60.5 years and the overall mortality was 43.8%. For public and private hospitals we found a median SOFA score of 7.5 and 7.1, and the mortality rate was 49.1% and 36.7%, respectively. Public and private hospitals had similar lengths of stay (median 10 and 9, respectively, P = 0.091). The total direct costs did not differ significantly ($9260 for public hospital vs $8776 for private hospital, P = 0.328).

Conclusions

Sepsis remains a major world health problem. Our data have not shown a significant difference in direct costs between public and private hospitals, perhaps our length of stay was also comparable. An accurate estimate of the cost of hospital care for septic patients would be essential to encourage physicians and healthcare managers to develop and implement evidence-based strategies to improve quality of care and to reduce costs in the ICU.