OBJECTIVES: Emerging data shows an association between hypotension during ICU stay with death and acute kidney injury (AKI). This analysis estimates the cost-savings per ICU patient that can accrue to US hospitals as a result of improved outcomes associated with hypotension reduction in sepsis.

METHODS: : In our economic analysis we estimated patient-level costs and the budget impact associated with hypotension reduction in septic ICU patients from the hospital perspective. The reduction in the probabilities of AKI and death were sourced from a prior EMR analysis in which hypotension exposure was defined by time-weighted average mean arterial pressure (TWA-MAP) and cumulative time in hours below 65 mmHg thresholds. Cost savings for each of the separate outcomes in sepsis was estimated from the current published literature. All dollars were adjusted to reflect 2018 costs. Scenario analyses and Monte Carlo simulations were performed to test the robustness of the model.

RESULTS: We ran six simulations (10,000 trials each) comparing 5, 10, 15, 20, 25 and 30 unit improvement in TWA-MAP to reach a baseline of 65 mmHg. Mean savings for the hospital associated with hypotension control ranged from $736 (5 unit change) to $6,648 (30 unit change) per patient. In each case, the 95% confidence interval exceeded $0. If causal, a 15 unit improvement in TWA-MAP from 50 to 65 (baseline) would yield expected saving of $3,137 (95% CI: $228-$9,472) per patient. Sensitivity analyses identified the rate of AKI, death and the cost of sepsis to have the greatest influence on hospital savings

CONCLUSIONS: As the US healthcare system moves toward pay for performance, well managed hospitals become very sensitive to cost control. In our study, hypotension reduction was shown to reduce hospitalization cost for septic ICU patients, with even a 5 unit improvement in hypotension control yielding substantial per patient cost savings.