Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

Takehiko Oami; Taro Imaeda; Taka-Aki Nakada; Toshikazu Abe; Nozomi Takahashi; Yasuo Yamao; Satoshi Nakagawa; Hiroshi Ogura; Nobuaki Shime; Yutaka Umemura; Asako Matsushima; Kiyohide Fushimi

doi:10.1186/s40560-022-00624-5

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

J Intensive Care. 2022 Jul 14;10(1):33. doi: 10.1186/s40560-022-00624-5.

Authors

Affiliations

¹ Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
² Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan. taka.nakada@nifty.com.
³ Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
⁴ Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.
⁵ Department of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.
⁶ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
⁷ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁸ Department of Emergency & Critical Care, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan.
⁹ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan.

Abstract

Background: Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined.

Methods: We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs.

Results: Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = - $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = - $1806/year [95% CI - $2432 to - $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs.

Conclusions: We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses.

Keywords: Cost-effectiveness; Critical care; Diagnosis procedure combination; Medical cost; Sepsis.