High-cost users (HCU) represent important targets for health policy interventions. Sepsis is a life-threatening syndrome that is associated with high morbidity, mortality, and economic costs to the healthcare system. We sought to estimate the effect of sepsis on being a subsequent HCU. Using linked health-administrative databases, we conducted a population-based, propensity score-weighted cohort study of adults who survived a hospitalization in Ontario, Canada between January 2016 and December 2017. Sepsis was identified using a validated algorithm. The primary outcome was being a persistent HCU after hospital discharge (in the top 5% or 1% of total health care spending for 90 consecutive days), and the proportion of follow-up time since discharge as a HCU. We identified 927,057 hospitalized individuals, of whom 79,065 had sepsis. Individuals who had sepsis were more likely to be a top 5% HCU for 90 consecutive days at any time after discharge compared to those without sepsis (OR 2.24; 95% confidence interval [CI] 2.04–2.46) and spent on average 42.3% of their follow up time as a top 5% HCU compared to 28.9% of time among those without sepsis (RR 1.46; 95% CI 1.45–1.48). Individuals with sepsis were more likely to be a top 1% HCU for 90 consecutive days compared to those without sepsis (10% versus 5.1%, OR 2.05 [95% CI 1.99–2.11]), and spent more time as a top 1% HCU (18.5% of time versus 10.8% of time, RR 1.68 [95% CI 1.65–1.70]). The sequelae of sepsis result in higher healthcare costs with important economic implications. After discharge, individuals who experienced sepsis are more likely to be a HCU and spend more time as a HCU compared to individuals who did not experience sepsis during hospitalization.

中文翻译：

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脓毒症后高成本使用者：一项基于人群的观察性队列研究


高成本用户 （HCU） 是卫生政策干预的重要目标。脓毒症是一种危及生命的综合征，与高发病率、死亡率和医疗保健系统的经济成本有关。我们试图估计脓毒症对后续 HCU 的影响。使用链接的卫生管理数据库，我们对 2016 年 1 月至 2017 年 12 月期间在加拿大安大略省住院治疗中幸存下来的成年人进行了一项基于人群的倾向评分加权队列研究。使用经过验证的算法识别脓毒症。主要结局是出院后持续存在 HCU （连续 90 天在医疗保健总支出的前 5% 或 1%），以及作为 HCU 出院后随访时间的比例。我们确定了 927,057 名住院患者，其中 79,065 名患有脓毒症。与无脓毒症的人相比，患有脓毒症的个体更有可能在出院后的任何时间连续 90 天成为前 5% 的 HCU （OR 2.24;95% 置信区间 [CI] 2.04-2.46），并且平均花费 42.3% 的随访时间作为前 5% 的 HCU，而无脓毒症的人为 28.9% 的时间 （RR 1.46;95% CI 1.45-1.48）。与无脓毒症患者相比，脓毒症患者更有可能连续 90 天成为前 1% 的 HCU（10% 对 5.1%，或 2.05 [95% CI 1.99-2.11]），并且作为前 1% 的 HCU 花费的时间更长（18.5% 的时间对 10.8% 的时间，RR 1.68 [95% CI 1.65-1.70]）。脓毒症的后遗症导致更高的医疗保健成本，具有重要的经济影响。出院后，与住院期间未患脓毒症的人相比，经历过脓毒症的人更有可能成为 HCU，并且作为 HCU 的时间更长。