New Data on Sepsis Prevalence and Costs ‘Astonished’ DHHS Researchers

By Christopher Cheney

The largest sepsis study every conducted with Medicare data found a 40% increase in the rate of Medicare beneficiaries hospitalized with the deadly infection from 2012 to 2018.

Sepsis is diagnosed in at least 1.7 million adults annually in the United States, according to the Centers for Disease Control and Prevention. About 270,000 Americans die from sepsis every year, and 1 in 3 patients who die in hospitals are diagnosed with sepsis, the CDC says.

The new study was conducted by researchers from the U.S. Department of Health and Human Services. The journal of Critical Care Medicine has published the research in three articles:

“We were astonished by the study’s results. To save lives in public health emergencies, we must solve sepsis. The findings of this study have implications not only for patient care, particularly after patients are discharged, but also for investments by industry, non-government organizations, and government agencies,” Rick Bright, PhD, a study co-author, DHHS deputy assistant secretary for preparedness and response, and director of the Biomedical Advanced Research and Development Authority, said in a prepared statement.

Research data

The study features several key data points:

  • From 2012 to 2018, the annual number of fee-for-service Medicare beneficiaries with an inpatient hospital admission and a sepsis diagnosis increased from 811,644 to 1,136,889.
  • During the study period, the total annual cost of inpatient hospital admissions among fee-for-service Medicare beneficiaries increased from $17.8 billion to $22.4 billion.
  • The total annual cost of skilled nursing facility (SNF) care for fee-for-service Medicare beneficiaries in the 90 days after a hospital inpatient discharge with a sepsis diagnosis increased from $3.9 billion to $5.6 billion.
  • For Medicare Advantage beneficiaries with a sepsis diagnosis, the total annual cost of inpatient admissions and SNF care increased from $6.0 billion to $13.4 billion.
  • The total annual cost for fee-for-service Medicare and Medicare Advantage beneficiaries with an inpatient admission for sepsis and SNF admission increased from $27.7 billion to $41.5 billion.
  • The study includes a conservative forecast for sepsis care costs in 2019 for all Medicare beneficiaries and private payer patients. Last year, the cost of sepsis care for inpatient admissions and SNF admissions for these patients was estimated at more than $62 billion.
  • The 6-month mortality rate among fee-for-service Medicare beneficiaries with an inpatient hospital admission was about 60% for septic shock (the most serious form of sepsis) and 36% for severe sepsis.
  • The 40% increase in the rate of Medicare beneficiaries hospitalized with sepsis from 2012 to 2018 cannot be accounted for fully by increased Medicare enrollment, which rose 22% during the study period.

Interpreting the data

The total cost of sepsis care is significantly higher than earlier estimates, according to the DHHS study.

A highly cited study published in 2016 estimated the cost of all acute hospital inpatient care for sepsis in 2013 was $23.7 billion. The DHHS study was limited to Medicare beneficiaries, who accounted for 61.5% of the patients in the 2016 study. So, the earlier study estimated the total cost for inpatient care among Medicare beneficiaries at about $15 billion.

“We observe that the projected 2019 cost of inpatient sepsis care alone (not including SNF) for Medicare FFS beneficiaries alone (not including Medicare Advantage) is $23.5 billion,” the DHHS study co-authors wrote.

The study provides new insights for the cost of sepsis care and the public health response necessary to address sepsis, they wrote.

“We now know the actual national expenditures for sepsis to far exceed widely cited contemporary estimates. The question is ‘exceed by how much?’ Answering this question requires new public-private partnerships that harmonize definitions of sepsis, that facilitate internal analyses and preparation of comparable summary data, and above all that promote the sharing of those summary data into the public space. Only when we understand the burdens, the trajectories, the predispositions, and the costs of sepsis can the nation fairly and prudently allocate the resources necessary to solve sepsis.”

Sepsis is a significant burden on Medicare beneficiaries, their families, and the Medicare program, the DHHS study co-authors wrote.

“The human and economic burdens of sepsis experienced by Medicare beneficiaries continue to grow. Although there are improvements in mortality and in cost-per-case throughout a pragmatic hierarchy of sepsis severity, the year-over-year growth of the beneficiary population, the year-over-year increase in the total number of sepsis deaths, and the year-over-year increase in the total cost of sepsis care highlight the need to understand how beneficiaries become septic, their clinical courses once septic, and how sepsis survivors fare following discharge from the acute care hospital,” they wrote.

Prevention and early detection of sepsis are critically important, the study co-authors wrote.

“Those strategies, which likely will require innovation in public health as well as improving individual immunoinflammatory health, are among the most promising strategies toward protecting populations and saving lives. Once sepsis is established, improving the immediate postsepsis trajectory—either by actions during the inpatient hospitalization or by actions during and after transfer to a facility offering prolonged care—appears to be an essential step toward value-based transformation of sepsis care.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.