Kosten der Sepsis

Moerer, Onnen; Burchardi, H.

doi:10.1007/s00101-006-1039-y

Cited by 12 publications

(8 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As data on intermediate care stays were not available, we chose this conservative approach in order to avoid overestimation of possible savings. Costs for antibiotic treatment in sepsis vary [3,7,13]. We chose to build a flexible range for these costs in our simulation model with average daily costs of € 66…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

Wilke¹,

Grube²,

Bodmann³

2011

Eur J Med Res

View full text Add to dashboard Cite

IntroductionThe management of bloodstream infections especially sepsis is a difficult task. An optimal antibiotic therapy (ABX) is paramount for success. Procalcitonin (PCT) is a well investigated biomarker that allows close monitoring of the infection and management of ABX. It has proven to be a cost-efficient diagnostic tool. In Diagnoses Related Groups (DRG) based reimbursement systems, hospitals get only a fixed amount of money for certain treatments. Thus it's very important to obtain an optimal balance of clinical treatment and resource consumption namely the length of stay in hospital and especially in the Intensive Care Unit (ICU). We investigated which economic effects an optimized PCT-based algorithm for antibiotic management could have.Materials and methodsWe collected inpatient episode data from 16 hospitals. These data contain administrative and clinical information such as length of stay, days in the ICU or diagnoses and procedures. From various RCTs and reviews there are different algorithms for the use of PCT to manage ABX published. Moreover RCTs and meta-analyses have proven possible savings in days of ABX (ABD) and length of stay in ICU (ICUD). As the meta-analyses use studies on different patient populations (pneumonia, sepsis, other bacterial infections), we undertook a short meta-analyses of 6 relevant studies investigating in sepsis or ventilator associated pneumonia (VAP). From this analyses we obtained savings in ABD and ICUD by calculating the weighted mean differences. Then we designed a new PCT-based algorithm using results from two very recent reviews. The algorithm contains evidence from several studies. From the patient data we calculated cost estimates using German National standard costing information for the German G-DRG system.We developed a simulation model where the possible savings and the extra costs for (in average) 8 PCT tests due to our algorithm were brought into equation.ResultsWe calculated ABD savings of -4 days and ICUD reductions of -1.8 days. our algorithm contains recommendations for ABX onset (PCT ≥ 0.5 ng/ml), validation whether ABX is appropriate or not (Delta from day 2 to day 3 ≥ 30% indicates inappropriate ABX) and recommendations for discontinuing ABX (PCT ≤ 0.25 ng/ml).We received 278, 264 episode datasets where we identified by computer-based selection 3, 263 cases with sepsis. After excluding cases with length of stay (LOS) too short to achieve the intended savings, we ended with 1, 312 cases with ICUD and 268 cases without ICUD. Average length of stay of ICU-patients was 27.7 ± 25.7 days and for Non-ICU patients 17.5 ± 14.6 days respectively. ICU patients had an average of 8.8 ± 8.7 ICUD.After applying the simulation model on this population we calculated possible savings of € -1, 163, 000 for ICU-patients and € -36, 512 for Non-ICU patients.DiscussionOur findings concerning the savings from the reduction of ABD are consistent with other publications. Savings ICUD had never been economically evaluated so far. our algorithm is able to possibly set a new ...

show abstract

Section: Methodsmentioning

confidence: 99%

“…Sepsis is a severe disease with poor clinical as economical outcomes and a high mortality [1-3]. Moreover sepsis treatment does often not adhere to practice recommendations [4].…”

Section: Introductionmentioning

confidence: 99%

The use of a standardized PCT-algorithm reduces costs in intensive care in septic patients - a DRG-based simulation model

Wilke¹,

Grube²,

Bodmann³

2011

Eur J Med Res

View full text Add to dashboard Cite

show abstract

“…About 85,000 patients a year survive severe sepsis or septic shock [2,3] in Germany. Main sepsis sequelae include critical illness polyneuropathy/myopathy, cognitive deficits and chronic pain, all symptoms of neuronal degeneration [4-7].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to the individual burden, sepsis causes significant health economic costs, about four to seven billion Euro/year for Germany alone, including indirect costs due to loss-of-work [3]. …”

Section: Introductionmentioning

confidence: 99%

Sepsis survivors monitoring and coordination in outpatient health care (SMOOTH): study protocol for a randomized controlled trial

Schmidt

Thiel

Mueller

et al. 2014

Trials

View full text Add to dashboard Cite

BackgroundSepsis sequelae include critical illness polyneuropathy, myopathy, wasting, neurocognitive deficits, post-traumatic stress disorder, depression and chronic pain. Little is known howlong-term sequelae following hospital discharge are treated. The aim of our study is to determine the effect of a primary care-based, long-term program on health-related quality of life in sepsis survivors.Methods/DesignIn a two-armed randomized multicenter interventional study, patients after sepsis (n = 290) will be assessed at 6, 12 and 24 months. Patients are eligible if severe sepsis or septic shock (ICD-10), at least two criteria of systemic inflammatory response syndrome (SIRS), at least one organ dysfunction and sufficient cognitive capacity are present. The intervention comprises 1) discharge management, 2) training of general practitioners and patients in evidence-based care for sepsis sequelae and 3) telephone monitoring of patients. At six months, we expect an improved primary outcome (health-related quality of life/SF-36) and improved secondary outcomes such as costs, mortality, clinical-, psycho-social- and process-of-care measures in the intervention group compared to the control group.DiscussionThis study evaluates a primary care-based, long-term program for patients after severe sepsis. Study results may add evidence for improved sepsis care management. General practitioners may contribute efficiently to sepsis aftercare.Trial registrationU1111-1119-6345. DRKS00000741, CCT-NAPN-20875 (25 February 2011).

show abstract

“…Rechnet man die indirekt verursachten Produktivitätsverluste hinzu, belaufen sich die Gesamtkosten der Sepsis in Deutschland hochgerechnet auf mehr als 6 Milliarden Euro pro Jahr [7].…”

unclassified