Table 2.
Description of post-sepsis healthcare costs in included studies
| First author and year | Time period of post-discharge costs | Cost types | Methods for cost estimation | Health costs payer | Costs | Measures of association |
|---|---|---|---|---|---|---|
| Barrett 2024 | 30-day intervals for up to 4 years | Physician visits, diagnostic tests, same-day surgery, hospitalizations, ED visits, rehabilitation, homecare, prescription drugs, complex continuing care, and long-term care | Individual-level healthcare costs were computed from the public payer’s perspective using a standardized costing methodology for Ontario health administrative databases at ICES | Universal public health insurance | Comparison of high-cost user status between sepsis survivors and individuals who survived a non-sepsis hospitalization | OR 2.24 (95% CI 2.04–2.46) for being a top 5% HCU at any point during discharge. RR 1.46 (95% CI 1.45–1.48) comparing proportion of time spent as a HCU. |
| Braun 2004 | 1 year following admission date of index hospitalization | Medical costs, total outpatient costs, cost of outpatient visits, ED visit costs, pharmacy costs, per-patient per-month (PPPM) outpatient costs, PPPM outpatient visit costs, PPPM pharmacy costs | Reported as defined costs: Costs paid out by insurer, excluding copays and deductibles incurred by patients | Private health insurance |
Survivors of post-discharge period: total mean medical costs = $28,541 ± SD $64,770 (median $7381); total mean outpatient costs = $13,201 ± $20,789 (median $6,907); mean ED visit costs = $1,135 ± $2,342 (median $361); mean pharmacy costs = $2,985 ± $2,342 (median $1,651); Non-survivors of post-discharge period: total mean medical costs = $50,303 ± $93,327 (median $14,720); total mean outpatient costs = $11,943 ± $24,705 (median $4,292); mean ED visit costs = $1,427 ± $3,380 (median $548); mean pharmacy costs = $1,405 ± $2,427 (median $510) |
None |
| Chang 2015 | 30 days post- discharge | 30-day readmission costs | Calculated using charges and cost-to charge ratios | Not specified | Median cost of a readmission within 30 days: $23,205 (IQR $12,668–$43,690) for sepsis. Annual costs of all 30-day readmissions: $600 million/year. | None |
| Farrah 2021 | 1-, 2-, 3-, 4-, and 5-years post-discharge | Hospitalizations, ED visits, inpatient rehabilitation, long-term and complex continuing care, physician, laboratory and homecare services, and prescription drugs | Individual-level healthcare costs were computed from the public payer’s perspective using a standardized costing methodology for Ontario health administrative databases at ICES [55] | Universal public health insurer |
Year 1 healthcare costs Severe sepsis: $61,117 (SD $71,835) Crude mean difference compared to controls: $22,939 Year 2 Severe sepsis: $28,737 (SD $44,981) Crude mean diff.: $11,368 Year 3 Severe sepsis: $26,919 (SD $41,042) Crude mean diff.: $10,084 Year 4 Severe sepsis: $25,869 (SD $39,279) Crude mean diff.: $9,364 Year 5 Severe sepsis: $25,815 (SD $40,071) Crude mean diff.: $9,415 Estimated 1-yr incremental costs of sepsis in Ontario total $1 billion. |
None |
| Fleischmann-Struzek 2021 | At 1 to 12 months, 13 to 24 months, and 25 to 36 months, among hospital survivors, 12-month survivors, and 24-month survivors | Sum of costs of hospitalizations, outpatient consultations, medication prescriptions, treatment prescriptions, and rehabilitation | Using a health insurance perspective, calculated per patient | Public health insurer |
Mean healthcare costs among all survivors: Year 1: $22,907 ± SD $38,054 (median $10,853) Year 2: $17,696 ± $31,979 (median $7,753) Year 3: $16,185 ± $29,453 per patient in the third year (median $7,087) Total mean healthcare costs in the 3 years after discharge: $44,747 per patient |
None |
| Gadre 2019 | 30 days post-discharge | Readmission costs (cost of hospitalization) | National estimates were produced for cost impact by using sampling weights provided by the sponsor | Not specified |
Mean cost for a readmission within 30 days: $18,980 Annual cost of sepsis readmission in the US: >$4 billion |
None |
| Goodwin 2015 | 30 days and 180 days after index hospital discharge | Cumulative readmission costs | Calculated using charges and cost-to-charge ratios | Commercial payor, Medicaid, Medicare, dual-eligible, and other |
Mean cost of each readmission: $31,490 (SD $47,862) Cumulative readmissions cost over 30 days: $452 million Cumulative readmissions cost over 180 days: $1.4 billion |
None |
| Lee 2004 | Years 1, 2, and 3 after hospital discharge | Hospitalization (excluding nursing home admission), ED, and same-day surgery visits within any of the three Calgary hospitals, all hospital admissions in Alberta, and all Alberta physician claims | Direct healthcare costs incurred by healthcare payor | Universal public health insurer |
Mean costs of care: Year 1: $26,698 Year 2: $9,139 Year 3: $9,078 |
None |
| Letarte 2002 | From 29 days up to 14.5 months after discharge | Follow-up costs after 28 days: prolonged hospitalization, readmission, ambulatory care | From a ministry of health perspective, based on use and unit cost | Public health insurance |
Total cost of prolonged hospitalization: $689,351 Total cost of readmission: $618,107 Total cost of ambulatory care: $26,498 |
None |
| Mageau 2019 | 1 year | Hospital costs (due to readmission) | Health administrative database | Not specified |
One-year healthcare use total cost (n = 738)1: $23,396 (SD $33,145) No significant difference in mean year 1 costs between sepsis survivors and controls, p = 0.3276 |
None |
| Nissenson 2005 | 12 weeks following the episode of care | Inpatient facility and physician services | Administrative and claims data from the United States Renal Data System | Medicare (federal health insurance for older adults) | Total cost of care over 12 weeks: $30,072/person (SD $35,637) | None |
| Pandolfi 2023 | 3 years | Ambulatory care and hospital care (inpatient and day care) | Health administrative database | Not described | Compared to the costs of pre-sepsis care ($3.6 billion), the total medical cost per patient was higher post-sepsis, reaching $4.9 billion | None |
| Paoli 2018 | 30 days following index hospitalization | Readmission costs | Billing records per the cost accounting method used by each hospital | Not specified |
Mean cost of 30-day all-cause readmission hospitalization: Sepsis without organ dysfunction: $16,679 (SD $26,956, median $10,142) Severe sepsis: $18,316 (SD $26,703, median $11,094) Septic shock: $21,660 (SD $34,111, median $12,568) |
None |
| Prescott 2014 | Throughout the 1 year following hospital discharge | Total Medicare spending, including inpatient and outpatient care | Insurance claims-based approach | Medicare |
Total Medicare spending in one year after discharge, median (IQR): Normal weight: $35,720 ($70,000) Overweight: $38,581 ($83,490) Obese: $50,741 ($89,186) Severely obese: $92,363 ($200,843) |
None |
| Puceta 2024 | 1 year | GP visits, specialist consultations, laboratory diagnostics, other outpatient care, and filled prescriptions of reimbursed medicines and medical products | Health administrative database | Public health insurance and patient co-payments |
Per patient, median at one year (IQR): Inpatient care (rehospitalizations): $1874 ($3,471) in sepsis, $1679 ($2,849) in non-sepsis, p < 0.001 Outpatient care (total): $334 ($624) sepsis, $385 ($657) non-sepsis, p < 0.001 PCP visits: $135 ($170) sepsis, $135 ($170) non-sepsis Specialist consultations: $86 (170) sepsis, $102 ($208) non-sepsis, p < 0.001 Laboratory diagnostics: $62 ($104) sepsis, $60 ($93) non-sepsis Other outpatient care: $119 ($3,648) sepsis, $133 ($363) non-sepsis, p = 0.005 Pharmaceuticals: $383 ($991) sepsis, $319 ($761) non-sepsis, p < 0.001 |
None |
| Rose 2023 | 1 year | Hospitalizations, outpatient consultations, medications, treatments (e.g., physical therapy, occupational therapy) and rehabilitation | Claims-based approach | Public payer |
1-year overall mean post-sepsis healthcare costs: $26,416 (SD $40,382) in hospital-acquired (HAI) sepsis patients, $21,747 (SD $14,707) in community-acquired (CAI) sepsis patients. In severe sepsis patients, overall mean healthcare costs at one year were $21,581 (SD $9,395) in CAI, $26,062 (SD $7,393) in HAI patients. |
None |
| Sankaran 2024 | 90 days | Inpatient and outpatient physician services, readmissions, hospital outpatient care, post-acute care, and outlier spending | Claims-based approach | Medicare | Mean 90-day episode spending on post-acute care: $5051 | None |
| Schmidt 2022 | 0–6 months, 7–12 months, and 13–24 months | Hospitalizations, rehabilitative care, GP visits, specialist visits, clinical diagnostics, prescription of allied health services, nursing care and medications | Medication costs were calculated using standardized pharmacy selling prices. All other costs were calculated using the German physician reimbursement scheme | Publicly funded health insurance |
Total direct costs per patient: 0–6 months: $25,224 (SD $34,466), median $8,701 7-12 months: $12,991 (SD $18,285), median $4,765 13–24 months: $26,911 (SD $30,781), median $18,458 |
None |
| Stinehart 2024 | 1 year | ED visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits | Claims-based approach | Employer health insurance | Overall median (IQR) healthcare expenditures at one year were: $24,525 ($13,428–$56,323) | None |
| Tew 2021 | 5 years | Inpatient hospitalizations, ED visits, cancer clinic visits, physician services, diagnostic tests, long-term care, prescription drugs, chemotherapy and radiotherapy | Individual-level healthcare costs were computed from the public payer’s perspective using a standardized costing methodology for Ontario health administrative databases at ICES | Universal public health insurer |
5-year total excess cost of care among patients who developed sepsis: Hematology patients: $69,491 (95% CI, $68,543-$70,440) Solid tumor patients: $55,565 (95% CI, $54,663-$56,465) Excess costs of care due to sepsis in year 1: Hematology patients: $42,239 (95% CI, $41,645-$42,834) Solid tumor patients: $26,614 (95% CI, $25,995-$27,233) |
None |
| Thompson 2018 | 2 years after treatment | Cost of ICU admission and cost of hospital admission, inclusive of ICU admission costs, 2 years after treatment | Costs for ICU admissions were measured using the New South Wales cost of care standards cost per bed per day. Total hospital costs were derived from matching Australian Refined Diagnostic Related Group codes to publicly available government reimbursement figures. | Not specified |
Total cost of hospital treatment to 2 years: Sepsis: $58,759 (SD $60,750) Non-sepsis: $52,168 (SD $47,451) p = 0.005 |
None |
| Weycker 2003 | At index admission, the 90- and 180-day periods following admission, and annually thereafter (up to 5 years) | Hospital admissions, outpatient visits (e.g., ED visits and physician office visits), and outpatient pharmacotherapy | Estimated using billed amounts for all paid facility, professional service, and outpatient pharmaceutical claims occurring between index admission and the end of follow-up | Private health insurance |
Mean cumulative costs at 1 year: $124,841 (SE $1,431) Mean cumulative costs at 5 years: $188,931 (SE $2,704) |
None |
| Winkler 2023 | At 7–12 months and at 13–36 months after sepsis hospitalization | Mean total healthcare costs as well as costs for hospitalizations, outpatient consultations, medications, treatments (e.g., physical therapy, occupational therapy), and rehabilitation | Measured as actual health expenditures from an insurance perspective and calculated per patient | Public health insurer |
Total mean healthcare costs at 7–12 months, in survivors without an ICU admission: $8,767 (95% CI, $8,229-$9,307) in rehabilitation group, $8,419 (95% CI, $8,232-$8,607) in non-rehabilitation group Total mean healthcare costs at 7–12 months, in survivors with an ICU admission: $9,760 (95% CI, $8,991-$10,349) in rehabilitation group, $10,333 (95% CI, $9,907-$10,759) in non-rehabilitation group |
None |
1n=738 refers to the total number of sepsis survivors in the study. The total sample size was 1,068, and 738 individuals survived post-discharge.
ICU: Intensive Care Unit
CI: Confidence Interval
SD: Standard Deviation
ED: Emergency Department
DRG: Diagnosis Related Groups
APACHE: Acute Physiology and Chronic Health Evaluation
GP: General Practitioner
PCP: Primary Care Practitioner
IQR: Interquartile Range
OR: Odds Ratio
RR: Relative Rate
HCU: High-Cost User