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Article

Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study

by
Konrad F. R. Schmidt
1,2,3,*,
Katharina Huelle
1,
Thomas Reinhold
4,
Hallie C. Prescott
5,6,
Rebekka Gehringer
1,
Michael Hartmann
7,
Thomas Lehmann
8,
Friederike Mueller
1,9,
Konrad Reinhart
2,10,
Nico Schneider
1,11,
Maya J. Schroevers
12,
Robert P. Kosilek
13,
Horst C. Vollmar
1,14,
Christoph Heintze
3,
Jochen S. Gensichen
1,2,13 and
the SMOOTH Study Group
1
Institute of General Practice and Family Medicine, Jena University Hospital, D-07743 Jena, Germany
2
Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747 Jena, Germany
3
Institute of General Practice and Family Medicine, Charité University Medicine, D-10117 Berlin, Germany
4
Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine, D-10117 Berlin, Germany
5
Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-5368, USA
6
VA Center for Clinical Management Research, Ann Arbor, MI 48105, USA
7
Hospital Pharmacy, Jena University Hospital, D-07747 Jena, Germany
8
Institute of Medical Statistics, Information Sciences and Documentation, Jena University Hospital, D-07747 Jena, Germany
9
Thiem-Research GmbH, Carl-Thiem-Klinikum, D-03048 Cottbus, Germany
10
Department of Anaesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, D-10117 Berlin, Germany
11
Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, D-07743 Jena, Germany
12
Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB Groningen, The Netherlands
13
Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336 Munich, Germany
14
Department of Family Medicine, Ruhr-University Bochum Medical School, D-44801 Bochum, Germany
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(4), 1142; https://doi.org/10.3390/jcm11041142
Submission received: 30 December 2021 / Revised: 9 February 2022 / Accepted: 11 February 2022 / Published: 21 February 2022
(This article belongs to the Special Issue Management of Chronic Critical Illness after Sepsis—Part II)
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Abstract

Background: Survivors of sepsis often face long-term sequelae after intensive care treatment. Compared to the period of hospitalization, little is known about the ambulatory healthcare utilization in sepsis patients. The study evaluated healthcare utilization and associated costs of sepsis care including allied health professions after initial hospitalization. Methods: Secondary analysis was performed on data in 210 sepsis patients prospectively enrolled from nine intensive care study centers across Germany. Data was collected via structured surveys among their Primary care (Family-) physicians (PCPs) within the first month after discharge from ICU (baseline) and again at 6, 12 and 24 months after discharge, each relating to the period following the last survey. Costs were assessed by standardized cost unit rates from a health care system’s perspective. Changes in healthcare utilization and costs over time were calculated using the Wilcoxon rank-sum test. Results: Of the 210 patients enrolled, 146 (69.5%) patients completed the 24 months follow-up. In total, 109 patients were hospitalized within the first 6 months post-intensive care. Mean total direct costs per patient at 0–6 months were €17,531 (median: €6047), at 7–12 months €9029 (median: €3312), and at 13–24 months €18,703 (median: €12,828). The largest contributor to the total direct costs within the first 6 months was re-hospitalizations (€13,787 (median: €2965). After this first half year, we observed a significant decline in inpatient care costs for re-hospitalizations (p ≤ 0.001). PCPs were visited by more than 95% of patients over 24 months. Conclusions: Sepsis survivors have high health care utilization. Hospital readmissions are frequent and costly. Highest costs and hospitalizations were observed in more than half of patients within the first six months post-intensive care. Among all outpatient care providers, PCPs were consulted most frequently. Clinical impact: Sepsis survivors have a high healthcare utilization and related costs which persist after discharge from hospital. Within outpatient care, possible needs of sepsis survivors as physiotherapy or psychotherapy seem not to be met appropriately. Development of sepsis aftercare programs for early detection and treatment of complications should be prioritized.
Keywords: sepsis; post-intensive care syndrome (PICS); health care costs; aftercare; critical illness; primary care sepsis; post-intensive care syndrome (PICS); health care costs; aftercare; critical illness; primary care

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MDPI and ACS Style

Schmidt, K.F.R.; Huelle, K.; Reinhold, T.; Prescott, H.C.; Gehringer, R.; Hartmann, M.; Lehmann, T.; Mueller, F.; Reinhart, K.; Schneider, N.; et al. Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study. J. Clin. Med. 2022, 11, 1142. https://doi.org/10.3390/jcm11041142

AMA Style

Schmidt KFR, Huelle K, Reinhold T, Prescott HC, Gehringer R, Hartmann M, Lehmann T, Mueller F, Reinhart K, Schneider N, et al. Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study. Journal of Clinical Medicine. 2022; 11(4):1142. https://doi.org/10.3390/jcm11041142

Chicago/Turabian Style

Schmidt, Konrad F. R., Katharina Huelle, Thomas Reinhold, Hallie C. Prescott, Rebekka Gehringer, Michael Hartmann, Thomas Lehmann, Friederike Mueller, Konrad Reinhart, Nico Schneider, and et al. 2022. "Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study" Journal of Clinical Medicine 11, no. 4: 1142. https://doi.org/10.3390/jcm11041142

APA Style

Schmidt, K. F. R., Huelle, K., Reinhold, T., Prescott, H. C., Gehringer, R., Hartmann, M., Lehmann, T., Mueller, F., Reinhart, K., Schneider, N., Schroevers, M. J., Kosilek, R. P., Vollmar, H. C., Heintze, C., Gensichen, J. S., & the SMOOTH Study Group. (2022). Healthcare Utilization and Costs in Sepsis Survivors in Germany–Secondary Analysis of a Prospective Cohort Study. Journal of Clinical Medicine, 11(4), 1142. https://doi.org/10.3390/jcm11041142

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