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Detailed cost analysis of care for survivors of severe sepsis

Lee, Helen MA; Doig, Christopher James MD, MSc; Ghali, William A. MD, MPH; Donaldson, Cam PhD; Johnson, David MD; Manns, Braden MD, MSc

doi: 10.1097/01.CCM.0000120053.98734.2C
CLINICAL INVESTIGATIONS
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Objectives The objectives of our study were to accurately describe the costs and resources required to treat survivors of severe sepsis subsequent to hospital discharge and to determine what factors influenced these costs.

Design Observational cohort study.

Setting Three regional intensive care units.

Patients Patients with severe sepsis admitted to one of three regional intensive care units in southern Alberta between April 1, 1996, and March 31, 1999.

Interventions None.

Measurements and Main Results Patients were identified using an intensive care unit research database; all survivors were followed prospectively for 3 yrs. Information on baseline patient characteristics, including acuity of illness (Acute Physiology and Chronic Health Evaluation II scores) and Charlson comorbidity scores, was collected. Costs considered included all episodes of inpatient and outpatient care and all physician claims. Of 787 patients who were admitted with severe sepsis, 502 survived to hospital discharge and were followed. Subsequent mean cost of care for years 1, 2, and 3 was CAN$20,855, $7,139 and $7,091, respectively. Using various regression models, the Acute Physiology and Chronic Health Evaluation II score and the Charlson comorbidity score were the only factors that consistently predicted higher healthcare costs in the first year after hospital discharge. Diabetes was the comorbid condition that best predicted subsequent cost.

Conclusions Cost of care for survivors of severe sepsis was highest in the first year after hospital discharge. Acuity of illness and patient comorbidity were the main determinants of cost. In assessing whether new therapeutic innovations for intensive care unit patients with severe sepsis are cost-effective, an accurate estimate of the cost of subsequent health care for survivors treated with and without the new intervention will be important.

From the Centre for Health and Policy Studies (HL, CD), Department of Community Health Sciences (CJD, WAG, CD, BM), and Department of Medicine (CJD, WAG, BM), University of Calgary, Alberta, Canada; School of Population and Health Sciences and Business School (CD), University of Newcastle upon Tyne, UK; Institute of Health Economics (WAG, BM), Edmonton, Alberta; Alberta Centre of Health Services Utilization Research (DJ), Edmonton, Alberta, Canada; and the Division of Critical Care Medicine (DJ), University of Alberta, Alberta, Canada.

Supported, in part, by The Institute of Health Economics, Edmonton, Alberta, Canada; by a New Investigator Award from the Canadian Institutes of Health Research (BM); by a Government of Canada Research Chair in Health Services Research (WAG); and by a Health Scholar Award from the Alberta Heritage Foundation for Medical Research (WAG).

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins