Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis
Objective: To describe mortality, healthcare resource utilization (HRU), and costs among Medicare beneficiaries with primary Clostridioides difficile infection (pCDI) or recurrent CDI (rCDI), with and without sepsis. Methods: We conducted a retrospective observational study of 100% Medicare Fee-for-...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-04-01
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| Series: | Therapeutic Advances in Infectious Disease |
| Online Access: | https://doi.org/10.1177/20499361221095679 |
| _version_ | 1818055314762629120 |
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| author | Alpesh Amin Winnie W. Nelson Jill Dreyfus Anny C. Wong Iman Mohammadi Christie Teigland David N. Dahdal Paul Feuerstadt |
| author_facet | Alpesh Amin Winnie W. Nelson Jill Dreyfus Anny C. Wong Iman Mohammadi Christie Teigland David N. Dahdal Paul Feuerstadt |
| author_sort | Alpesh Amin |
| collection | DOAJ |
| description | Objective: To describe mortality, healthcare resource utilization (HRU), and costs among Medicare beneficiaries with primary Clostridioides difficile infection (pCDI) or recurrent CDI (rCDI), with and without sepsis. Methods: We conducted a retrospective observational study of 100% Medicare Fee-for-Service claims from adults aged ⩾ 65 years with ⩾1 CDI episode between 1 January 2009 and 31 December 2017. Patients were continuously enrolled in Medicare Parts A/B/D 12 months before and up to 12 months after pCDI. ICD-9/10 codes defined CDI using ⩾1 inpatient claim, or ⩾1 outpatient claim plus ⩾1 claim for CDI treatment. The pCDI episode ended after 14 days without a CDI claim. rCDI episodes started within 8 weeks from the end of a previous CDI episode. ICD-9/10 codes identified all-cause sepsis over 12 month follow-up. Results: Of 497,489 CDI patients, 41.0% ( N = 203,888) had sepsis; 57.7% with sepsis died versus 32.4% without sepsis. Among patients with pCDI only ( N = 345,893) or ⩾1 rCDI ( N = 151,596), 39.2% and 45.1% suffered sepsis, respectively. All-cause hospitalizations were frequent for all cohorts (range: 81–99%). Among patients who died, those with sepsis versus without had more-frequent intensive care unit (ICU) use (pCDI: 29% versus 15%; rCDI: 65% versus 34%), longer hospital stays (pCDI: 12 versus 10 days; rCDI: 12 versus 9 days), and higher per-patient-per-month costs (pCDI: $34,841 versus $22,753; rCDI: $42,269 versus $25,047). In both cohorts, sepsis patients who survived had higher total costs and all-cause HRU than those without sepsis. All p < 0.001 above. Conclusions: Sepsis was common among Medicare beneficiaries with CDI. CDI patients with sepsis, especially after an rCDI, experienced higher mortality, HRU, and costs compared with those without sepsis. |
| first_indexed | 2024-12-10T12:10:59Z |
| format | Article |
| id | doaj.art-abbb9dcc0674471183814314791ac6da |
| institution | Directory Open Access Journal |
| issn | 2049-937X |
| language | English |
| last_indexed | 2024-12-10T12:10:59Z |
| publishDate | 2022-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Infectious Disease |
| spelling | doaj.art-abbb9dcc0674471183814314791ac6da2022-12-22T01:49:22ZengSAGE PublishingTherapeutic Advances in Infectious Disease2049-937X2022-04-01910.1177/20499361221095679Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsisAlpesh AminWinnie W. NelsonJill DreyfusAnny C. WongIman MohammadiChristie TeiglandDavid N. DahdalPaul FeuerstadtObjective: To describe mortality, healthcare resource utilization (HRU), and costs among Medicare beneficiaries with primary Clostridioides difficile infection (pCDI) or recurrent CDI (rCDI), with and without sepsis. Methods: We conducted a retrospective observational study of 100% Medicare Fee-for-Service claims from adults aged ⩾ 65 years with ⩾1 CDI episode between 1 January 2009 and 31 December 2017. Patients were continuously enrolled in Medicare Parts A/B/D 12 months before and up to 12 months after pCDI. ICD-9/10 codes defined CDI using ⩾1 inpatient claim, or ⩾1 outpatient claim plus ⩾1 claim for CDI treatment. The pCDI episode ended after 14 days without a CDI claim. rCDI episodes started within 8 weeks from the end of a previous CDI episode. ICD-9/10 codes identified all-cause sepsis over 12 month follow-up. Results: Of 497,489 CDI patients, 41.0% ( N = 203,888) had sepsis; 57.7% with sepsis died versus 32.4% without sepsis. Among patients with pCDI only ( N = 345,893) or ⩾1 rCDI ( N = 151,596), 39.2% and 45.1% suffered sepsis, respectively. All-cause hospitalizations were frequent for all cohorts (range: 81–99%). Among patients who died, those with sepsis versus without had more-frequent intensive care unit (ICU) use (pCDI: 29% versus 15%; rCDI: 65% versus 34%), longer hospital stays (pCDI: 12 versus 10 days; rCDI: 12 versus 9 days), and higher per-patient-per-month costs (pCDI: $34,841 versus $22,753; rCDI: $42,269 versus $25,047). In both cohorts, sepsis patients who survived had higher total costs and all-cause HRU than those without sepsis. All p < 0.001 above. Conclusions: Sepsis was common among Medicare beneficiaries with CDI. CDI patients with sepsis, especially after an rCDI, experienced higher mortality, HRU, and costs compared with those without sepsis.https://doi.org/10.1177/20499361221095679 |
| spellingShingle | Alpesh Amin Winnie W. Nelson Jill Dreyfus Anny C. Wong Iman Mohammadi Christie Teigland David N. Dahdal Paul Feuerstadt Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis Therapeutic Advances in Infectious Disease |
| title | Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis |
| title_full | Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis |
| title_fullStr | Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis |
| title_full_unstemmed | Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis |
| title_short | Mortality, healthcare resource utilization, and cost among Medicare beneficiaries with infection with and without sepsis |
| title_sort | mortality healthcare resource utilization and cost among medicare beneficiaries with infection with and without sepsis |
| url | https://doi.org/10.1177/20499361221095679 |
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