Sogayar, Ana M. C., Machado, Flavia R., Rea-Neto, Alvaro, Dornas, Amselmo, Grion, Cintia M. C., Lobo, Suzana M. A., Tura, Bernardo R., Silva, Carla L. O., Cal, Ruy G. R., Beer, Idal, Michels Jr, Vilto, Safi Jr, Jorge, Kayath, Marcia, Silva, Eliezer, Michels, Vilto, Safi, Jorge, and Costs Study Group - Latin American Sepsis Institute
BACKGROUND: Sepsis has a high prevalence within intensive care units, with elevated rates of morbidity and mortality, and high costs. Data on sepsis costs are scarce in the literature, and in developing countries such as Brazil these data are largely unavailable. Enrolled patients were assessed daily in terms of cost-related expenditures such as hospital fees, operating room fees, gas therapy, physiotherapy, blood components transfusion, medications, renal replacement therapy, laboratory analysis and imaging. Standard unit costs (year 2006 values) were based on the Brazilian Medical Association (AMB) price index for medical procedures and the BRASINDICE price index for medications, solutions and hospital consumables. Medical resource utilization was also assessed daily using the Therapeutic Intervention Scoring System (TISS-28). Indirect costs were not included. The median total cost of sepsis was $US9632 (interquartile range [IQR] 458318 387; 95% CI 8657, 10 672) per patient, while the median daily ICU cost per patient was $US934 (IQR 7351170; 95% CI 897, 963). The median daily ICU cost per patient was significantly higher in non-survivors than in survivors, i.e. $US1094 (IQR 8881341; 95% CI 1058, 1157) and $US826 (IQR 668982; 95% CI 786, 854), respectively (p < 0.001). For patients admitted to public and private hospitals, we found a median SOFA score at ICU admission of 7.5 and 7.1, respectively (p = 0.02), and the mortality rate was 49.1% and 36.7%, respectively (p = 0.006). Patients admitted to public and private hospitals had a similar length of stay of 10 (IQR 519) days versus 9 (IQR 416) days (p = 0.091), and the median total direct costs for public ($US9773; IQR 464319 221; 95% CI 8503, 10 818) versus private ($US9490; IQR 430517 034; 95% CI 7610, 11 292) hospitals did not differ significantly (p = 0.37). OBJECTIVES: To assess the standard direct costs of sepsis management in Brazilian intensive care units (ICUs) and to disclose factors that could affect those costs. Enrolled patients were assessed daily in terms of cost-related expenditures such as hospital fees, operating room fees, gas therapy, physiotherapy, blood components transfusion, medications, renal replacement therapy, laboratory analysis and imaging. Standard unit costs (year 2006 values) were based on the Brazilian Medical Association (AMB) price index for medical procedures and the BRASINDICE price index for medications, solutions and hospital consumables. Medical resource utilization was also assessed daily using the Therapeutic Intervention Scoring System (TISS-28). Indirect costs were not included. The median total cost of sepsis was $US9632 (interquartile range [IQR] 458318 387; 95% CI 8657, 10 672) per patient, while the median daily ICU cost per patient was $US934 (IQR 7351170; 95% CI 897, 963). The median daily ICU cost per patient was significantly higher in non-survivors than in survivors, i.e. $US1094 (IQR 8881341; 95% CI 1058, 1157) and $US826 (IQR 668982; 95% CI 786, 854), respectively (p < 0.001). For patients admitted to public and private hospitals, we found a median SOFA score at ICU admission of 7.5 and 7.1, respectively (p = 0.02), and the mortality rate was 49.1% and 36.7%, respectively (p = 0.006). Patients admitted to public and private hospitals had a similar length of stay of 10 (IQR 519) days versus 9 (IQR 416) days (p = 0.091), and the median total direct costs for public ($US9773; IQR 464319 221; 95% CI 8503, 10 818) versus private ($US9490; IQR 430517 034; 95% CI 7610, 11 292) hospitals did not differ significantly (p = 0.37).… [ABSTRACT FROM AUTHOR]