PRM41 - ESTIMATION OF HOSPITAL COST SAVINGS ASSOCIATED WITH HYPOTENSION REDUCTION IN SEPTIC INTENSIVE CARE UNIT PATIENTS IN FRANCE

Abstract

Emerging data shows an association between hypotension during ICU stay with death and acute kidney injury (AKI). This analysis estimates the cost-savings per ICU patient that can accrue to French hospitals as a result of improved outcomes associated with hypotension reduction in sepsis. In our economic analysis we estimated patient-level costs and the budget impact associated with hypotension reduction in septic ICU patients from the hospital perspective. The reduction in the probabilities of AKI and death were sourced from a prior EMR analysis in which hypotension exposure was defined by time-weighted average mean arterial pressure (TWA-MAP) and cumulative time in hours below 65 mmHg thresholds. Cost savings for each of the separate outcomes in sepsis was estimated from the current literature on cost of French sepsis hospitalization and a multivariate analysis reporting marginal hospitalization costs of AKI. We use the French HICP Index (General) from OECD to update costs. Scenario analyses and Monte Carlo simulations were performed to test the robustness of the model. 6 separate simulations (10,000 trials per simulation) comparing 5, 10, 15, 20, 25 and 30 unit improvement in TWA-MAP to reach a baseline of 65 mmHg. Mean savings for the hospital associated with hypotension control ranged from €471 (5 unit change) to €4,270 (30 unit change) per patient. In each case, the 95% confidence interval exceeded €0. If causal, a 15 unit improvement in TWA-MAP from 50 to 65 (baseline) would yield expected saving of €2,010 (95% CI: €97 - €6,113) per patient. In our study, hypotension reduction was shown to reduce hospitalization cost for septic ICU patients with even a 5 unit improvement in hypotension control yielding substantial per patient cost savings to hospitals in France.