Economic impact of kidney patients with sepsis in hospital setting

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Yuri Battaglia

Yuri Battaglia1, Franco Guerzoni2, Manuel Gigante1, Marco Veronesi1, Chiara Oppi3, Elena Forini4, Ines Ullo5, Emidia Vagnoni3, Alda Storari1

1 UOC di Nefrologia e Dialisi, AOU "Sant’Anna", Ferrara, Italia
2 Nucleo Aziendale Controlli, AOU "Sant’Anna", Ferrara, Italia
3 Dipartimento di Economia e Management, Università di Ferrara, Italia
4 Ufficio Statistico, AOU "Sant’Anna", Ferrara, Italia
5 UOC di Nefrologia e Dialisi, ASST Sette Laghi, Varese, Italia

Corrispondenza a:
Yuri Battaglia, PhD
Dipartimento Onco-Medico Specialistico
Unità Operativa Complessa di Nefrologia e Dialisi
Azienda Ospedaliero-Universitaria Sant’Anna, Ferrara
Via A. Moro, 8 Cona (Fe)
Cell. +393934320061
Email: battagliayuri@gmail.com
ORCID: 0000-0003-3947-1814

 

Abstract

Introduction: Over the last decades, sepsis has become a real medical emergency, with a high mortality rate and often requiring admission to an intensive care unit. An increasing number of CKD patients contracts sepsis due to several clinical risk factors (use of catheters, immunosuppressive therapy, comorbidity, etc.) and is treated in Nephrology wards, generating additional costs that are not covered by hospital Diagnosis Related Groups (DRG) reimbursement. The aim of the study is to evaluate the costs of sepsis in one Nephrology Unit and to detect the mortality rate of CKD patients with sepsis.

Methods: We conducted a retrospective study on a cohort of CKD patients admitted into one Nephrology Unit in 2017. CKD inpatients were divided in two groups: patients with sepsis (SP) and without (control group). Socio-demographic, clinical and therapeutic data, as well as routine biochemistry, were collected through a “sepsis form”. SP were identified thanks to hospital discharge records (HDR). The hospital-related costs of a SP were obtained by summing up: (1) the average cost of an inpatient day of care for the average length of stay in the Nephrology Unit; (2) the average cost of the antimicrobial therapy, as recorded on the clinical folder.

Results: Among the 408 CKD inpatients, 61 were septic. The overall average cost of a SP was 23.087,57 €; the average cost of the hospital stay and of the antimicrobial therapy was 19.364,98 € and 3.722,60 € respectively. The average length of stay in the Nephrology Unit was 16.7 days. The in-hospital mortality rate was 41.7%, with a 312% additional mortality rate.

Conclusions: SP had an overall average cost three times higher than CKD inpatients without sepsis (9.290,79 €). This additional cost was due to a longer hospital stay (8.7 days more on average) and a higher cost of antimicrobial therapy per case (€ 221,24). A national multi-centre study is needed to confirm our data and to promote an adjustment of reimbursement tariff for DRG-sepsis, which is now applicable only to an ICU setting. 

Keywords: sepsis, costs, kidney disease, hospital discharge register

Sorry, this entry is only available in Italian.

Introduzione

La sepsi rappresenta una condizione clinica frequente di difficile gestione.  È associata a una mortalità molto elevata quando si accompagna a insufficienza d’organo (20-25%) o a uno stato di shock settico (40-70%), ed è pertanto definita un’emergenza medica [1].

La Consensus Conference della Society of Critical Care Medicine (SCCM) nel 2003, ha elaborato le definizioni di sepsi, sepsi grave e shock settico con lo scopo di rendere omogenea la terminologia utilizzata in questo ambito [2,3]. Recentemente, nuove definizioni sono state messe a punto nella Terza Consensus Conference della SCCM nel 2016 [4], che non hanno modificato nessun aspetto nell’identificazione e nel trattamento di questa patologia, ma hanno reso ridondante il termine “sepsi grave” che è stato sostituito da “sepsi” (Fig.1).

Gli studi epidemiologici riguardo la sepsi, attualmente disponibili, sono estremamente eterogenei e comprendono valutazioni retrospettive, incentrate sulle diagnosi di dimissione ospedaliera, e valutazioni prospettiche, basate su indagini osservazionali [5,6].

 

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Cost analysis of haemodialysis catheter related bloodstream infection through the DRG system, “on behalf of Project Group of Vascular Access of Italian Society of Nephrology”

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Salvatore Mandolfo

Salvatore Mandolfo1, Milena Maggio1, Giacomo Forneris2, Franco Galli3

1 UOC di Nefrologia e dialisi – Ospedale Maggiore Lodi
2 UOC di Nefrologia e Dialisi – Centro di Ricerche di Immunopatologia e Documentazione Malattie Rare – Ospedale San Giovanni Bosco e Università di Torino
3 BEL – Bioengineering  Laboratories Cantù

Autore corrispondente:
Salvatore Mandolfo
UOC di Nefrologia e Dialisi – Ospedale Maggiore di Lodi
Viale Savoia 1
26900 Lodi
Telefono: 0371/372731
e-mail : mandolfo@alice.it

 

Abstract

Catheter related bloodstream infections (CRBSI) represent a complication that often requires hospitalization and the use of economic resources. In Italy, there is no literature that considers the costs of CRBSI for tunneled catheters (CVCt).

The aim of this work is to evaluate the relative costs of CRBSI through the DRG system.

From 2012 to 2017 we examined 2.257 hospital discharge forms, 358 of which relating to haemodialysis patients. Patients with CVCt (167), compared to FAVs (157), on average stay in hospital longer (10 vs. 8 days), entail higher costs (+8.5%) and higher admissions rate for infections (+114%). The incidence of CRBSI was 0.67 episodes per 1000 CVCt/days. CRBSI accounts for 23% of the cases of hospitalization of patients with CVCt and 5.2% of total hospitalization costs. Complicated CRBSI involve a 9% increase in average costs compared to simple ones, with patients staying in hospital three times longer. The cost of a CRBSI varies from €4,080 up to €14,800, with an average cost of €5,575. The costs calculated here are less than a third of that reported in American literature but this can be explained by the different reimbursement rates systems. The methodology of CRBSI costs through DRGs appears simple, and its main limit is the correct compilation of the discharge form. This is a reminder that discharge forms are an integral part of the medical record and can become important in recognizing the cost of the medical services provided.

Keywords: hospital costs, CRBSI, central venous catheter

Sorry, this entry is only available in Italian.

Introduzione

Il catetere venoso centrale tunnellizzato (CVCt) rappresenta, dopo la fistola artero venosa, l’accesso vascolare più frequentemente utilizzato nei pazienti in emodialisi in Italia. Gli ultimi dati ufficiali riportano una prevalenza del 18.4% della popolazione (1), ma è verosimile ipotizzare che tale dato sia abbastanza sottostimato e che almeno un terzo della popolazione ne sia portatore. 

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