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

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.

Epidemiology of sepsis in a Japanese administrative database

“…The remaining 20 studies included patients with sepsis with both infection and organ dysfunction (Figure 1). Of the 20 studies investigating patients with sepsis, 6 examined patients with sepsis as a whole, regardless of the site of infection and organ dysfunction 13–18 . The remaining 14 studies included only sepsis with pneumonia, perforation of the lower gastrointestinal tract, or shock 12,19–31 .…”

“…Of the 20 studies investigating patients with sepsis, 6 examined patients with sepsis as a whole, regardless of the site of infection and organ dysfunction. [13][14][15][16][17][18] The remaining 14 studies included only sepsis with pneumonia, perforation of the lower gastrointestinal tract, or shock. 12,[19][20][21][22][23][24][25][26][27][28][29][30][31] Four studies on patients with sepsis overall were based on the same cohort [13][14][15][16] (Table 1).…”

“…[13][14][15][16][17][18] The remaining 14 studies included only sepsis with pneumonia, perforation of the lower gastrointestinal tract, or shock. 12,[19][20][21][22][23][24][25][26][27][28][29][30][31] Four studies on patients with sepsis overall were based on the same cohort [13][14][15][16] (Table 1).…”

“…The claims-based database has population-based statistics on diagnosis, treatment, and medical costs during hospital stays, covering more than 80% of all acute care hospitals in 2019. 12 Using this database, several epidemiological studies have revealed an increasing number of patients with sepsis and an escalating cost of sepsis-related medical care in Japan's super-aging society 13,14 ; however, there is a lack of literature review to obtain a comprehensive understanding of population-based studies in Japan. In this review, we describe the epidemiology, clinical management, and medical costs of patients with sepsis who had an infection and organ dysfunction, which is linked with Sepsis-3 using a Japanese administrative database.…”

Impact of hospital volume on mortality and cost in sepsis based on a Japanese nationwide medical claims database study

“…The value of medical costs comprises the total medical fees for drugs, examinations, laboratory tests, radiological tests, and surgical procedures. Reimbursement of medical fees was mainly determined based on the most common payment diagnosis and medical procedures performed during the hospital stay on the bundled payment basis; however, we calculated the total fees according to the reference prices in the Japanese fee schedule, as described in a previous report 34 . Considering the different admission years of the patients included in the study, the value of medical costs was standardized by the consumer index price in each year.…”