Liesl M. Cooper

Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care.

IntroductionInfection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels.MethodsData for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels.ResultsThere were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of

Growth of intensive care unit resource use and its estimated cost in Medicare

3.4 billion per year.ConclusionSevere sepsis is a common, deadly, and costly complication in cancer patients.

Medicare intensive care unit use: Analysis of incidence, cost, and payment*

Objective:The past 10–15 yrs brought significant changes in the United States healthcare system. Effects on Medicare intensive care unit use and costs are unknown. Intensive care unit costs are estimated using the Russell equation with a ratio of intensive care unit to floor cost per day, or “R value,” of 3, which may no longer be valid. We sought to determine contemporary Medicare intensive care unit resource use, costs, and R values; whether these vary by patient and hospital characteristics; and the impact of updated values on estimated intensive care unit costs. Design:Retrospective analysis of Medicare Inpatient Prospective Payment System hospitalizations from 1994 to 2004 using Medicare Provider Analysis and Review files. Setting:All nonfederal acute care US hospitals paid through the Inpatient Prospective Payment System. Subjects:Inpatient prospective payment system hospitalizations from 1994 to 2004 (n = 121,747, 260). Interventions:None. Measurements and Main Results:We examined resource use and costs (adjusted to y2004

Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras Results From the US Medicare Program

), calculating intensive care unit and floor costs directly and using these to generate year-specific R values. By 2004, 33% of Medicare hospitalizations had intensive care unit or coronary care unit care, with more than half of the increase in total hospitalizations because of additional intensive care unit hospitalizations. Adjusted intensive care unit cost per day remained stable (

Impact of Drotrecogin alfa (activated) on Resource Use and Implications for Reimbursement

2,616 vs.

A Sepsis Review: Epidemiology, Economics, and Disease Characteristics

2,575; 1994 vs 2004), yet adjusted floor cost per day rose substantially (

HOSPITAL AND FOLLOW-UP COSTS IN A SEVERE SEPSIS MANAGED CARE POPULATION: 516

1,027 vs.

ID4: THE CONFUSION BETWEEN SEPTICEMIA AND SEVERE SEPSIS

1,488) driven by decreased floor length of stay. Annual adjusted Medicare intensive care unit costs increased 36% to

An upper estimate of the attributable mortality and cost of severe sepsis in surgical patients

32.3B, largely because of increased utilization. R values decreased progressively from 2.55 to 1.73, were lower for surgical vs. medical admissions and survivors vs. nonsurvivors, but varied little by hospital characteristics. An R value of 3 overestimated Medicare intensive care unit costs by 17.6% (

Abstract 2988: Changes in Coronary Revascularization Treatment Patterns Among Diabetic Patients: Results from the U.S. Medicare Program

5.7 billion) in 2004. Conclusions:Medicare intensive care unit use is rising rapidly and will likely continue to do so. Despite significant healthcare system changes, adjusted daily critical care costs remained stable, yet care outside the intensive care unit became more expensive. To track intensive care unit cost over time, year-specific R values should be used.