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PharmacoEconomics

, Volume 26, Issue 5, pp 425–434 | Cite as

A Multicentre, Prospective Study to Evaluate Costs of Septic Patients in Brazilian Intensive Care Units

  • Ana M. C. Sogayar
  • Flavia R. Machado
  • Alvaro Rea-Neto
  • Amselmo Dornas
  • Cintia M. C. Grion
  • Suzana M. A. Lobo
  • Bernardo R. Tura
  • Carla L. O. Silva
  • Ruy G. R. Cal
  • Idal Beer
  • Vilto MichelsJr
  • Jorge SafiJr
  • Marcia Kayath
  • Eliezer SilvaEmail author
Original Research Article

Abstract

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.

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.

Methods

This multicentre observational cohort study was conducted in adult septic patients admitted to 21 mixed ICUs of private and public hospitals in Brazil from 1 October 2003 to 30 March 2004. Complete data for all patients admitted to the ICUs were obtained until their discharge or death. We collected only direct healthcare-related costs, defined as all costs related to the ICU stay.

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.

Results

With a mean (standard deviation [SD]) age of 61.1 ± 19.2 years, 524 septic patients from 21 centres were included in this study. The overall hospital mortality rate was 43.8%, the mean Acute Physiology And Chronic Health Evaluation II (APACHE II) score was 22.3 ± 5.4, and the mean Sequential Organ Failure Assessment (SOFA) score at ICU admission was 7.5 ± 3.9.

The median total cost of sepsis was $US9632 (interquartile range [IQR] 4583–18 387; 95% CI 8657, 10 672) per patient, while the median daily ICU cost per patient was $US934 (IQR 735–1170; 95% CI 897, 963). The median daily ICU cost per patient was significantly higher in non-survivors than in survivors, i.e. $US1094 (IQR 888–1341; 95% CI 1058, 1157) and $US826 (IQR 668–982; 95% CI 786, 854), respectively (p < 0.001). For patients admitted to public and private hospitals, we found a median SOFA score at ICU admission of 7.5 and 7.1, respectively (p = 0.02), and the mortality rate was 49.1% and 36.7%, respectively (p = 0.006). Patients admitted to public and private hospitals had a similar length of stay of 10 (IQR 5–19) days versus 9 (IQR 4–16) days (p = 0.091), and the median total direct costs for public ($US9773; IQR 4643–19 221; 95% CI 8503, 10 818) versus private ($US9490; IQR 4305–17 034; 95% CI 7610, 11 292) hospitals did not differ significantly (p = 0.37).

Conclusions

The present study provides the first economic analysis of direct costs of sepsis in Brazilian ICUs and reveals that the cost of sepsis treatment is high. Despite similar ICU management, there was a significant difference regarding patient outcome between private and public hospitals. Finally, the median daily costs of non-survivor patients were higher than survivors during ICU stay.

Keywords

Severe Sepsis Sequential Organ Failure Assessment Equipment Usage Sequential Organ Failure Assessment Score Therapeutic Intervention Scoring System 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

In addition to the authors, the following institutions and investigators participated in the study as clinical sites.

Hospital São Paulo (UNIFESP): Gutemberg de Souza Cardoso, Ley Bueno; Hospital das Clínicas (UFPR): Nazah Cherif Youssef; Hospital Mater Dei: Adriano Dantas; Hospital de Base: Adriana Carta, Marco Aurélio Spegioriu; Hospital Universitário Regional Norte do Paraná (UEL): Cíntia M.C. Grion; Hospital Laranjeiras (Instituto Nacional de Cardiologia): Bernardo R. Tura; Hospital Geral do Grajaú: Tatiana Mohovic, Regina Helena Lima Caltabiano; Hospital Israelita Albert Einstein: Elias Knobel, Evandro José de Araújo Figueiredo, Thereza Phitoe Abe Ferreira; Hospital Pró-Cardiaco: Rubens Costa Filho, André Assis de Albuquerque, Maurício Vaisman; Hospital São Lucas (PUC): Iuri C. Wawrzeniak, Fernando S. Dias; Hospital Municipal Professor Alípio Corrêa Neto: Fátima Barbosa Cordeiro, Wilson Roberto Oliver, Elcio Tarkieutab; Hospital Português: José Mário Meira Teles; Hospital Santa Luzia: Marcelo de O. Maia, Henrique Marconi Sampaio Pinhati; Hospital Bandeirantes: Mário Lúcio Alves Baptista Filho, Cláudio Nazareno do Prazer Conceição, Luiz Antônio Carvalho Ribeiro; Hospital das Clínicas (UNESP): Ana Lucia Gut, Mirna Matsui, Ana Lúcia dos A. Ferreira; Casa de Saúde São José: Fábio G. de Miranda; Hospital Municipal São José: Milton Caldeira Filho, Glauco Adrieno Westphal, Francine Bagnati, Mariane De Cas De Aquim; Hospital Beneficência Portuguesa: Daniela Ortega, Renata Alberini, Haggeas da Silveira Fernandes; Hospital Vera Cruz: Dinalva Aparecida Mendes, Fernando Carvalho Neuenschwander, Eliane Maria Ferreira de Moura; Hospital Sírio Libanês: Guilherme Schettino, Elton Scaramal; Hospital Nossa Senhora das Graças: Cassiana Pulgatti, Heitor João Lagos.

We are also indebted to Frederico Rafael Moreira, who served as the statistics consultant.

This study was sponsored by an educational grant from Eli Lilly Brazil. Jorge Safi and Marcia Kayath were employees of Eli Lilly at the time the study was conducted. The authors have no other conflicts of interest that are directly relevant to the content of this study.

References

  1. 1.
    Angus DC, Pereira CA, Silva E. Epidemiology of severe sepsis around the world. Endocr Metab Immune Disord Drug Targets 2006 Jun; 6 (2): 207–212PubMedCrossRefGoogle Scholar
  2. 2.
    Silva E, Pedro MA. Brazilian Sepsis Epidemiological Study (BASES study). Crit Care 2004 Aug; 8 (4): R251–R260PubMedCrossRefGoogle Scholar
  3. 3.
    Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546–1554PubMedCrossRefGoogle Scholar
  4. 4.
    Moerer O, Schmid A, Hofmann M, et al. Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 2002 Oct; 28 (10): 1440–1446PubMedCrossRefGoogle Scholar
  5. 5.
    Burchardi H, Schneider H. Economic aspects of severe sepsis: a review of intensive care unit costs, cost of illness and cost effectiveness of therapy. Pharmacoeconomics 2004; 22 (12): 793–813PubMedCrossRefGoogle Scholar
  6. 6.
    Edbrooke D, Hibbert C, Ridley S, et al., and The Intensive Care Working Group on Costing. The development of a method for comparative costing of individual intensive care units. Anaesthesia 1999; 54: 110–120PubMedCrossRefGoogle Scholar
  7. 7.
    Lee H, Doig CJ, Ghali WA, et al. Detailed cost analysis of care for survivors of severe sepsis. Crit Care Med 2004; 32 (4): 981–985PubMedCrossRefGoogle Scholar
  8. 8.
    Edbrooke DL, Hibbert CL, Kingsley JM, et al. The patient-related cost of care for sepsis patients in a United Kingdom adult general intensive care unit. Crit Care Med 1999; 27: 1760–1767PubMedCrossRefGoogle Scholar
  9. 9.
    Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29: 1303–1310PubMedCrossRefGoogle Scholar
  10. 10.
    Brun-Buisson C, Roudot-Thoraval F, Girou E et al. The costs of septic syndromes in the intensive care unit and influence of hospital-acquired sepsis. Intensive Care Med 2003; 29: 1464–1471PubMedCrossRefGoogle Scholar
  11. 11.
    Ministério da Saúde. Brazilian healthcare database: DAT ASUS [online]. Available from URL: http://tabnet.datasus.gov.br [Accessed 2007 Aug 1]Google Scholar
  12. 12.
    Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med 1985 Oct; 13 (10): 818–829PubMedCrossRefGoogle Scholar
  13. 13.
    Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996 Jul; 22 (7): 707–710PubMedCrossRefGoogle Scholar
  14. 14.
    Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis: the ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992 Jun; 101 (6): 1644–1655PubMedCrossRefGoogle Scholar
  15. 15.
    Brazilian Medical Association. Price index for medical procedures [online]. Available from URL: http://www.amb.org.br [Accessed 2007 Aug 1]
  16. 16.
    Brasíndice price index [online]. Available from URL: http://www.brasindice.com.br [Accessed 2007 Aug 1]
  17. 17.
    Miranda DR, de Rijk A, Schaufeli W. Simplified therapeutic intervention scoring system: the TISS-28 items. Results from a multicenter study. Crit Care Med 1996 Jan; 24 (1): 64–73PubMedCrossRefGoogle Scholar
  18. 18.
    Spiegel MR. Theory and problems of probability and statistics. New York: McGraw-Hill, 1992: 116–117Google Scholar
  19. 19.
    Lehmann EL. Nonparametric statistical methods based on ranks. New York: McGraw-Hill, 1975Google Scholar
  20. 20.
    Fisher LD, van Belle G. Biostatistics: a methodology for health sciences. New York: John Wiley and Sons, 1993Google Scholar
  21. 21.
    Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: John Wiley and Sons, 2000CrossRefGoogle Scholar
  22. 22.
    Letarte J, Longo CJ, Pelletier J, et al. Patient characteristics and costs of severe sepsis and septic shock in Quebec. J Crit Care 2002; 17 (1): 39–49PubMedCrossRefGoogle Scholar
  23. 23.
    Schmid A, Burchardi H, Clouth J, et al. Burden of illness imposed by severe sepsis in Germany. Eur J Health Econ 2002; 3 (2): 77–82PubMedCrossRefGoogle Scholar
  24. 24.
    Braun L, Riedel AA, Cooper LM. Severe sepsis in managed care: analysis of incidence, one-year mortality, and associated costs of care. J Manag Care Pharm 2004 Nov–Dec; 10 (6): 521–530PubMedGoogle Scholar
  25. 25.
    Chalfin DB, Burchardi H. Definitions and methods of cost assessment: an intensivist’s guide. ESICM section on health research and outcome working group on cost effectiveness. Intensive Care Med 2002 Jun; 28 (6): 680–685PubMedCrossRefGoogle Scholar
  26. 26.
    Sales Jr JA, David CM, Hatum R, et al. Sepse Brasil: estudo epidemiologico da sepse em unidades de terapia intensiva brasileiras. RBTI 2006, 17Google Scholar
  27. 27.
    Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med 2004 Apr; 30 (4): 536–555PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Ana M. C. Sogayar
    • 1
  • Flavia R. Machado
    • 2
  • Alvaro Rea-Neto
    • 3
  • Amselmo Dornas
    • 4
  • Cintia M. C. Grion
    • 5
  • Suzana M. A. Lobo
    • 6
  • Bernardo R. Tura
    • 7
  • Carla L. O. Silva
    • 8
  • Ruy G. R. Cal
    • 1
  • Idal Beer
    • 1
  • Vilto MichelsJr
    • 8
  • Jorge SafiJr
    • 9
  • Marcia Kayath
    • 9
  • Eliezer Silva
    • 1
    • 8
    Email author
  1. 1.Hospital Israelita Albert EinsteinSão PauloBrazil
  2. 2.Hospital São Paulo (UNIFESP)São PauloBrazil
  3. 3.Hospital das Clínicas da Universidade Federal do Paraná (UFPR)CuritibaBrazil
  4. 4.Hospital Mater DeiBelo HorizonteBrazil
  5. 5.Hospital Universitário da Universidade Estadual de LondrinaLondrinaBrazil
  6. 6.Hospital de BaseSão José do Rio PretoBrazil
  7. 7.Instituto Nacional de CardiologiaRio de JaneiroBrazil
  8. 8.Instituto Latino Americano para Estudos da SepseSão PauloBrazil
  9. 9.Eli Lilly do BrasilSão PauloBrazil

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