title: Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use.
abstract: OBJECTIVE
  To determine the direct costs of severe sepsis patients in German intensive care units (ICUs).
  
  
  METHODS
  Retrospective electronic data analysis.
  
  
  METHODS
  Three adult intensive care units (surgical/medical) in three university hospitals in Germany.
  
  
  METHODS
  385 patients identified by standard definitions as suffering from severe sepsis.
  
  
  RESULTS
  A bottom-up approach was used to determine the direct ICU cost on actual resource use (medication, laboratory tests, microbiological analysis, disposables, and clinical procedures) for patients with severe sepsis. To determine the total direct costs, center-specific personnel and basic bed ("hotel") costs were added to total resources consumed. Average hospital mortality of severely septic patients was 42.6%. Mean ICU length of stay (LOS) was 16.6 days. Survivors stayed on average 4 days longer than nonsurvivors. The mean direct ICU costs of care were 23,297+/-18,631 euros per patient and 1,318 euros per day. In comparison, average daily charges being paid for an ICU patient by the health care system in Germany are 851 euros (based on official statistics). Nonsurvivors were more expensive than survivors in total direct costs (25,446 vs. 21,984 euros) and in per day direct cost (1,649 vs. 1,162 euros). Medication makes up the largest part of the direct costs, followed by expenses for personnel. CONCLUSIONS. Patients with severe sepsis have a high ICU mortality rate and long ICU LOS and are substantially expensive to treat. Nonsurviving septic patients are more costly than survivors despite shorter ICU LOS. This is due to higher medication costs indicating increased efforts to keep patients alive.
authors.affiliation: Department of Anesthesiology, Emergency, and Intensive Care Medicine, University Hospital Göttingen, Robert-Koch-Strasse 40, 37070 Göttingen, Germany. omoerer@gwdg.de
authors.forename: Onnen
authors.initials: O
authors.lastname: Moerer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schmid
authors.forename: Michael
authors.initials: M
authors.lastname: Hofmann
authors.forename: Anja
authors.initials: A
authors.lastname: Herklotz
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Heinz
authors.initials: H
authors.lastname: Schneider
authors.forename: Hilmar
authors.initials: H
authors.lastname: Burchardi
mesh_terms: D000328:Adult; D000368:Aged; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000191:economics* / Q000628:therapy*; D016019:Survival Analysis