Healthcare costs after sepsis: a systematic review

Abstract

Sepsis is a life-threatening syndrome associated with significant health resource utilization. Previous systematic reviews have demonstrated high healthcare costs during hospitalization with sepsis, but post-discharge health costs have not been characterized. Understanding these costs allows health system decision-makers to identify targets for reducing preventable spending and strain on healthcare resources. This systematic review aims to describe the post-hospitalization healthcare costs among adults living in developed nations who survived an episode of sepsis. We searched MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials and Database of Systematic Reviews from the year 2000 to February 4, 2025. The search strategy was developed by combining concepts of sepsis, costs, study types, and developed countries. Two reviewers independently screened titles and abstracts, followed by full-text review and data extraction. Conflicts were resolved by a third reviewer. Study quality was assessed using the Newcastle-Ottawa scale for non-randomized studies. Narrative synthesis was used to summarize findings. We identified 23 observational studies that met the inclusion criteria. The methods used to calculate and report healthcare costs varied widely across studies, including the types of costs incurred (readmissions, physician visits, medication costs, and others) and the period over which costs were calculated. Across studies, the median total healthcare cost among sepsis survivors in year one after discharge was $28,719 (IQR $21,715) and the median total healthcare cost in year two after discharge was $22,460 (IQR $14,407). The median cost of a readmission for sepsis survivors was $20,320 (IQR $4,889). Six of seven studies that included a non-sepsis comparator group reported that sepsis survivors accrue higher healthcare costs post-discharge compared to individuals without sepsis. Our systematic review demonstrates that sepsis survivors incur high healthcare costs that can persist for years after discharge from initial hospitalization. These findings underscore the long-term health economic burden of sepsis, highlighting sepsis as an important target for policy and practice interventions that could improve health outcomes and reduce costs. CRD42023456850.