Sepsis is the most expensive hospital condition to treat and the leading cause of hospital deaths.1 Timely recognition of the signs and symptoms is critical to halting the life-threatening deterioration of sepsis and reducing the enormous burden on patients and hospital costs.
The Astounding Costs of Treating Sepsis
In spite of awareness campaigns that have made important strides in detecting and treating sepsis in hospital patients, recent studies reveal some alarming statistics about the costs of sepsis care in hospitals. For example, the total annual hospital costs of treating sepsis in the United States are estimated at more than $24 billion – the approximate equivalent of the gross domestic product of Honduras.
In early 2019, GE Healthcare and Roche examined the complicated issue of the economics of sepsis. Together with David Kulick, a healthcare economics consultant, they described the difficulties hospitals have in gaining clarity and accurate information on the direct and indirect costs of sepsis3. As sepsis cuts across clinical and operational areas within hospitals, hospitals have struggled to fully identify the true cost burden of sepsis.
Hospitals with the largest volume of sepsis cases, or the most severe cases, present opportunities to ramp up their efforts to improve sepsis recognition and treatment. Innovative new technologies that provide powerful tools for recognizing and responding to signs of deterioration at the right time and with the appropriate intervention can reduce the economic burden and devastating impact on patients and should be included in any continued explorations of the costs of sepsis.
A Second Look at Sepsis Costs
In taking a deeper dive into the economic impact of sepsis, Kulick has continued to examine the costs of sepsis across a wide range of variables.
“Sepsis can be looked at in a variety of ways,” he said. “Further, the costs fluctuate across geography, hospital size, whether rural or urban, teaching or non-teaching hospital, and whether sepsis is present-on-admission or is hospital acquired.”
This means that there is no one standard hospital cost and further the range is significant.
Not a One-Size-Fits-All Condition
As might be expected, the data show that larger hospitals experience a greater volume of more severe sepsis cases, suggesting a potentially higher cost burden for sepsis care and treatment than smaller hospitals. However, further gradations come into play.
In sorting out the volume of sepsis cases by hospital size and academic affiliation, large rural non-teaching hospitals seem to have the greatest volume of sepsis cases followed by rural teaching hospitals, then urban non-teaching hospitals, and finally, by urban teaching hospitals. In contrast, small urban teaching hospitals were found to have the largest proportion of sepsis cases, with rural non-teaching hospitals the least.
“This suggests an opportunity to focus on large rural non-teaching hospitals as a primary opportunity for sepsis improvement efforts,” said Kulick. “The finding also provides insights into how health systems may want to focus their sepsis intervention efforts and resources based on their facilities’ sepsis volume and burden.”
When it comes to estimating costs, Kulick found that hospitals with academic affiliations appear to have the highest costs per case even though large non-teaching hospitals may experience larger case volume, suggesting that teaching hospitals may treat patients that require a higher level of care. This cost variation applies to both urban and rural teaching hospitals, demonstrating that cost analyses may not be uniform across hospitals based on size, as well as regional and academic affiliation differences may apply.
Similarly, the research also found differences in reimbursement payments that fluctuate based on geography and academic affiliation. These disparities in reimbursement data imply that urban hospital reimbursement is higher than rural hospital payments across all levels of sepsis severity—although academic affiliation seems to drive higher reimbursement than non-teaching hospitals. The exception is septic shock and severe sepsis, which are the costliest forms of sepsis and carry the greatest economic burden and mortality.2
According to Kulick, “these findings highlight that reimbursement, like the variations found in hospital costs, is more nuanced than even our cost model suggests and creates a case for further primary research.”
More Questions Call for Further Research
While Kulick concludes that his first analysis of sepsis was a step in assessing the true sepsis impact on institutions, he also emphasizes, “The more we look, the more questions are raised.” The findings around the burden of sepsis, costs of care, and fluctuating reimbursement by size, geography, and academic affiliation all call for continued research in order to fully understand and address the substantial economic impact of sepsis.
What we do know from this further analysis is that that economics of sepsis remain complex and that early detection and treatment remain pivotal to reducing sepsis costs and mortality.
1. Margin of Excellence: Lowering the Incidence and Severity of Hospital-Associated Sepsis, Premier, Inc. March 2019. https://www.premierinc.com/newsroom/press-releases/premier-inc-analysis-hospital-associated-sepsis-decreased-by-15-from-2015-2018Accessed December 1, 2019.
2. Epidemiology and Costs of Sepsis in the United States—An Analysis Based on Timing of Diagnosis and Severity Level, Critical Care Medicine, December 2018. https://www.ncbi.nlm.nih.gov/pubmed/30048332Accessed December 1, 2019.
3. The Untold Economic Story of Sepsis in U.S. Hospitals, white paper; David Kulick, MPH, Shailja Vaghela, MPH, Erin Bina