Außerordentliche ökonomische Belastung - Epidemiologie und Kosten der Sepsis

Zusammenfassung

Noch immer ist die schwere Sepsis eine der Haupttodesursachen auf der Intensivstation und damit eine große Bedrohung für die Patienten. So entwickeln 2-3 % der Patienten einer Normalstation und 10-15 % der Intensivpatienten eine schwere Sepsis oder einen septischen Schock. Allein in Deutschland erkranken jedes Jahr zwischen 44000 und 95000 Menschen an schwerer Sepsis, und 30-50 % dieser Patienten versterben während ihres Krankenhausaufenthalts. Aber auch wenn diese die Sepsis anfänglich überleben, bleibt ihr Mortalitätsrisiko noch über Jahre hinweg erhöht - und zwar abhängig von Aufnahmeursache, Krankheitsschwere, Alter, Nebenerkrankungen und der Lokalisation der zugrunde liegenden Infektion. Aus der hohen Inzidenz und dem großen Anteil kostenintensiver intensivmedizinischer Behandlungsmaßnahmen resultieren hohe Krankenhauskosten. Ergänzt man auch die so genannten indirekten Kosten, ergeben sich für Deutschland jährliche Aufwendungen zwischen 3647 und 7847 Milliarden Euro. Damit ist die Sepsis eine außerordentliche ökonomische Belastung, sodass die Entwicklung neuer therapeutischer Standards sowie eingehende Untersuchungen zu den Kosten dringend erforderlich sind.

Summary

Despite great efforts in clinical research severe sepsis remains a serious health care problem being among the leading causes of death in intensive care therapy. 2-3 % of ward patients and 10-15 % ICU patients develop severe sepsis or septic shock. Every year between 44000 and 95000 patients in Germany suffer from severe sepsis and 30-50 % of them are dying from the disease during their hospital stay. But even after initial survival mortality is increased in these patients for several years. The mortality is influenced by reason of admission, severity of illness, age, comorbidities and primary site of infection. Due to the incidence and the expensive effort of intensive care therapy of such patients, sepsis consumes considerable recourses and results in significant hospital costs. Adding indirect costs due to temporary or permanent morbidity severe sepsis imposes annual costs between 3647 und 7847 billion Euros in Germany. Thus, sepsis is a tremendous cost driver not only from the ICU but also from hospital or society's perspective. There is an urgent need for therapeutic standards and innovative therapies in the treatment of sepsis to improve outcome as well as for further cost studies to improve our knowledge.

sepsis - cost of treatment - health care costs - hospital costs

Literatur

• 1 Angus DC, Linde-Zwirble WT, Clermont G. et al. . Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis.  Crit Care Med. 2003;  31 1-11
• 2 Angus DC, Linde-Zwirble WT, Lidicker J. et al. . Epidemiology of severe sepsis in the united states: analysis of incidence, outcome, and associated costs of care.  Crit Care Med. 2001;  29 1303-1310
• 3 Annane D. Corticosteroids for septic shock.  Crit Care Med. 2001;  29 S117-S120
• 4 Bernard GR, Vincent JL, Laterre PF. et al. . Efficacy and safety of recombinant human activated protein C for severe sepsis.  N Engl J Med. 2001;  344 699-709
• 5 Brun-Buisson C, Doyon F, Carlet J. et al. . Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicentre prospective study in intensive care units. French ICU Group for Severe Sepsis.  JAMA. 1995;  274 968-974
• 6 Chalfin DB, Holbein ME, Fein AM, Carlon GC. Cost-effectiveness of monoclonal antibodies to gram-negative endotoxin in the treatment of gram-negative sepsis in ICU patients.  JAMA. 1993;  269 249-254
• 7 Cohen IL, Booth FV. Cost containment and mechanical ventilation in the United States.  New Horiz. 1994;  2 283-290
• 8 Dietrich ES, Schubert B, Ebner W, Daschner F. Cost efficacy of tazobactam/piperacillin versus imipenem/cilastatin in the treatment of intra-abdominal infection.  Pharmacoeconomics. 2001;  19 79-94
• 9 Edbrooke DL, Stevens VG, Hibbert CL. et al. . A new method of accurately identifying costs of individual patients in intensive care: the initial results.  Intensive Care Med. 1997;  23 645-650
• 10 Gatell JM, Trilla A, Latorre X. et al. . Nosocomial bacteremia in a large Spanish teaching hospital: analysis of factors influencing prognosis.  Rev Infect Dis. 1988;  10 203-210
• 11 Heyland DK, Hopman W, Coo H. et al. . Long-term health-related quality of life in survivors of sepsis. Short form 36: a valid and reliable measure of health-related quality of life.  Crit Care Med. 2000;  28 3599-3605
• 12 Heyland DK, Tranmer JE. Measuring family satisfaction with care in the intensive care unit: the development of a questionnaire and preliminary results.  J Crit Care. 2001;  16 142-149
• 13 Jacobs P, Edbrooke D, Hibbert C. et al. . Descriptive patient data as an explanation for the variation in average daily costs in intensive care.  Anaesthesia. 2001;  56 643-647
• 14 Jegers M, Edbrooke DL, Hibbert CL. et al. . Definitions and methods of cost assessment: an intensivist's guide. ESICM Section on Health Research and Outcome Working Group on Cost Effectiveness.  Intensive Care Med. 2002;  28 680-685
• 15 Knaus WA, Harrell Jr FE, LaBrecque JF. et al. . Use of predicted risk of mortality to evaluate the efficacy of anticytokine therapy in sepsis. The RhIL-1ra Phase III Sepsis Syndrome Study Group.  Crit Care Med. 1996;  24 46-56
• 16 Letarte J, Longo CJ, Pelletier J. et al. . Patient characteristics and costs of severe sepsis and septic shock in Quebec.  J Crit Care. 2002;  17 39-49
• 17 Liljas B. How to calculate indirect costs in economic evaluations.  Pharmacoeconomics. 1998;  13 1-7
• 18 Lucioni C, Mazzi S, Currado I.. Sepsis costs in Italy.  Intensive Care Med. 2001;  27
• 19 Lundberg JS, Perl TM, Wiblin T. et al. . Septic shock: an analysis of outcomes for patients with onset on hospital wards versus intensive care units.  Crit Care Med. 1998;  26 1020-1024
• 20 Manns BJ, Lee H, Doig CJ. et al. . An economic evaluation of activated protein C treatment for severe sepsis.  N Engl J Med. 2002;  347 993-1000
• 21 Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000.  N Engl J Med. 2003;  348 1546-1654
• 22 Moerer O. Cost assessment in the ICU.  Journal für Anästhesiologie und Intensivbehandlung. 2001;  175-177
• 23 Moerer O, Burchardi H. Cost profiles of direct variable costs in ICU patients.  Intensive Care Med. 2001;  206
• 24 Moerer O, Hein S, Schürgers D, Burchardi H. Cost of infections in the ICU - a matched pairs study.  Intensive Care Med. 2000;  26
• 25 Moerer O, Schmid A, Hofmann M. et al. . Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use.  Intensive Care Med. 2002;  28 1440-1446
• 26 Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients.  Crit Care Med. 1997;  25 1789-1795
• 27 Neilson A, Moerer O, Burchardi H, Schneider H. DRG-based reimbursement of services in German intensive care units: a new concept.  Intensive Care Med. 2004; 
• 28 Neilson AR, Burchardi H, Chinn C. et al. . Cost-effectiveness of drotrecogin alfa (activated) for the treatment of severe sepsis in Germany.  J Crit Care. 2003;  18 217-227
• 29 Norris C, Jacobs P, Rapoport J, Hamilton S. ICU and non-ICU cost per day.  Can J Anaesth. 1995;  42 192-196
• 30 Noseworthy TW, Konopad E, Shustack A. et al. . Cost accounting of adult intensive care: methods and human and capital inputs.  Crit Care Med. 1996;  24 1168-1172
• 31 Opal SM, Cohen J. Clinical gram-positive sepsis: does it fundamentally differ from gram-negative bacterial sepsis?.  Crit Care Med. 1999;  27 1608-1616
• 32 Oye RK, Bellamy PE. Patterns of resource consumption in medical intensive care.  Chest. 1991;  99 685-689
• 33 Perl TM, Dvorak L, Hwang T, Wenzel RP. Long-term survival and function after suspected gram-negative sepsis.  JAMA. 1995;  274 338-345
• 34 Pittet D, Rangel-Frausto S, Li N. et al. . Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients.  Intensive Care Med. 1995;  21 302-309
• 35 Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality.  JAMA. 1994;  271 1598-1601
• 36 Pittet D, Thievent B, Wenzel RP. et al. . Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients.  Am J Respir Crit Care Med. 1996;  153 684-693
• 37 Pittet D, Thievent B, Wenzel RP. et al. . Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients.  Intensive Care Med. 1993;  19 265-272
• 38 Ponce de Leon-Rosales SP, Molinar-Ramos F, Dominguez-Cherit G. et al. . Prevalence of infections in intensive care units in Mexico: a multicentre study.  Crit Care Med. 2000;  28 1316-1321
• 39 Quartin AA, Schein RM, Kett DH, Peduzzi PN. Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group.  JAMA. 1997;  277 1058-1063
• 40 Rello J, Ricart M, Mirelis B. et al. . Nosocomial bacteremia in a medical-surgical intensive care unit: epidemiologic characteristics and factors influencing mortality in 111 episodes.  Intensive Care Med. 1994;  20 94-98
• 41 Ridley S, Biggam M, Stone P. Costs of intensive therapy. A description of methodology and initial results.  Anaesthesia. 1991;  46 523-630
• 42 Rivers E, Nguyen B, Havstad S. et al. . Early goal-directed therapy in the treatment of severe sepsis and septic shock.  N Engl J Med. 2001;  345 234-240 1368-1377
• 43 Salvo I, de W Cian, Musicco M. et al. . The Italian SEPSIS Study: preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shock.  Intensive Care Med.. 1995;  21 S244-S249
• 44 Sands KE, Bates DW, Lanken PN. et al. . Epidemiology of sepsis syndrome in 8 academic medical centers. Academic Medical Center Consortium Sepsis Project Working Group.  JAMA. 1997;  278 234-240
• 45 Schmid A, Burchardi H, Clouth J, Schneider H. Burden of illness imposed by severe sepsis in Germany.  Eur J Health Econom. 2002;  3 77-82
• 46 Schmid A, Schneider H. The economic burden of sepsis in Austria.  Wien Klin Wochenschr. 2002;  114 1023-1024
• 47 Teres D, Rapoport J, Lemeshow S. et al. . Effects of severity of illness on resource use by survivors and nonsurvivors of severe sepsis at intensive care unit admission.  Crit Care Med. 2002;  30 2413-2419
• 48 Tsang GM, Khan I, Dar M. et al. . Hemofiltration in a cardiac intensive care unit: time for a rational approach.  ASAIO J. 1996;  42 M710-M713
• 49 van den Berghe G, Wouters P, Weekers F. et al. . Intensive insulin therapy in the critically ill patients.  N Engl J Med. 2001;  345 1359-1367
• 50 Welton JM, Meyer AA, Mandelkehr L. et al. . Outcomes of and resource consumption by high-cost patients in the intensive care unit.  Am J Crit Care. 2002;  11 467-473
• 51 Weycker D, Akhras KS, Edelsberg J. et al. . Long-term mortality and medical care charges in patients with severe sepsis.  Crit Care. 2003;  31 2316-2323
• 52 Yu DT, Black E, Sands KE. et al. . Severe sepsis: variation in resource and therapeutic modality use among academic centers.  Crit Care. 2003;  7 R24-R34

1 acute physiology and chronic health evaluation

2 administration of drotrecogin alfa (activated) in early severe sepsis

Anschrift für die Verfasser