Critical care management of severe sepsis and septic shock: a cost-analysis

Background
Sepsis treatment has been associated with high costs. Furthermore,
both the incidence of sepsis and the severity of illness at
presentation appear to be increasing. We estimated healthcare
costs related to the treatment of patients with sepsis in the
intensive care unit (ICU) and aimed to explain variability in
costs between individuals.
Methods
We performed a prospective cohort study in patients presenting
with severe sepsis or septic shock to the ICUs of two tertiary
centres in the Netherlands. Resource use was valued using a
bottom-up micro-costing approach. Multivariable regression
analysis was used to study variability in costs.
Results
Overall, 651 patients were included, of which 294 presented with
septic shock. Mean costs were €2250 (95% CI €2235-€2266) per
day and €29,102 (95% CI €26,598-€31,690) per ICU admission.
Of the total expenditure, 74% was related to accommodation,
personnel, and disposables, 12% to diagnostic procedures, and
14% to therapeutic interventions. Patients with septic shock
had higher costs compared with patients with severe sepsis
(additional costs: €69 (95% CI €37-€100) per day, and €8355
(95% CI €3400-€13,367) per admission). Site of infection,
causative organism, presence of shock, and immunodeficiency
were independently associated with costs, but explained only
11% of the total variance.
Conclusion
Mean costs of sepsis care in the ICU were almost €30,000 per
case. As costs were poorly predictable, opportunities for cost
savings based on patient profiling upon admission are limited.