Journal Article

High-cost users after sepsis: a population-based observational cohort study

Rosella, Laura, Dodek, Peter, Chung, Hannah, Scales, Damon C., Barrett, Kali A., Chechulina, Victoria, Thavorn, Kednapa, Sheikh, Fatima

2024

Overview

Background High-cost users (HCU) represent important targets for health policy interventions. Sepsis is a life-threatening syndrome that is associated with high morbidity, mortality, and economic costs to the healthcare system. We sought to estimate the effect of sepsis on being a subsequent HCU. Methods Using linked health-administrative databases, we conducted a population-based, propensity score-weighted cohort study of adults who survived a hospitalization in Ontario, Canada between January 2016 and December 2017. Sepsis was identified using a validated algorithm. The primary outcome was being a persistent HCU after hospital discharge (in the top 5% or 1% of total health care spending for 90 consecutive days), and the proportion of follow-up time since discharge as a HCU. Results We identified 927,057 hospitalized individuals, of whom 79,065 had sepsis. Individuals who had sepsis were more likely to be a top 5% HCU for 90 consecutive days at any time after discharge compared to those without sepsis (OR 2.24; 95% confidence interval [CI] 2.04–2.46) and spent on average 42.3% of their follow up time as a top 5% HCU compared to 28.9% of time among those without sepsis (RR 1.46; 95% CI 1.45–1.48). Individuals with sepsis were more likely to be a top 1% HCU for 90 consecutive days compared to those without sepsis (10% versus 5.1%, OR 2.05 [95% CI 1.99–2.11]), and spent more time as a top 1% HCU (18.5% of time versus 10.8% of time, RR 1.68 [95% CI 1.65–1.70]). Conclusions The sequelae of sepsis result in higher healthcare costs with important economic implications. After discharge, individuals who experienced sepsis are more likely to be a HCU and spend more time as a HCU compared to individuals who did not experience sepsis during hospitalization.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Algorithms / Analysis / Canada / Chronic illnesses / Cohort analysis / Cohort Studies / Cost control / Critical Care Medicine / Datasets / Economic aspects / Emergency medical care / Emergency Medicine / Female / Health Care Costs - statistics & numerical data / Health Care Costs - trends / Health care expenditures / Hospitalization / Hospitalization - economics / Hospitalization - statistics & numerical data / Hospitals / Humans / Infection / Intensive / Length of stay / Long term health care / Male / Medical economics / Medicine / Medicine & Public Health / Middle Aged / Mortality / Ontario / Ontario - epidemiology / Personal health / Population / Propensity Score / Sepsis / Sepsis - economics / Sepsis - epidemiology / Ventilators