Abstract
Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.
Highlights
Sepsis is a life-threatening organ dysfunction due to infection [1]
At 6, 12, and 24 months, primary care physicians (PCPs) data were available in 92.4% (n = 129), 84.3% (n = 177) and 69.5% (n = 146) of the study population, respectively, see Figure 1
40 patients dropped out due to mortality, 25 data queries were rejected by the PCPs
Summary
Sepsis is a life-threatening organ dysfunction due to infection [1]. As a global major health concern, it results in 15 to 19 million deaths per year [1]. Surviving sepsis patients are confronted with long-term consequences of their critical illness, including new or worsened functional, cognitive, or psychiatric impairment and increased risk for medical deterioration [7] Despite these long-term consequences of sepsis, there is no structured post-hospital rehabilitation program for sepsis survivors [7]. Multiple studies documented high rates of hospital readmissions and associated costs in intensive care unit (ICU) survivors [14–17]. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965) After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized
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