In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+ hospitals across the US, Boston Strategic Partners (BSP) Clinical Insights report, Hospital Treated Sepsis, estimates 30% of all hospital discharges involve treatment of infectious organisms. Sepsis is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections account for $212 billion in annual spending or 7% of total healthcare expenditure. In this report, we conduct an in-depth analysis of sepsis patient characteristics, medication management, costs, and laboratory testing. The Hospital-Treated Sepsis Report is available at www.bostonsp.com/reports Gram-positive bacteria are the likely causative agents of most sepsis infections. Physicians treat the vast majority of these infections with vancomycin, piperacillin-tazobactam, levofloxacin, and ceftriaxone. From 2010-2015, drug-resistant organisms caused an astonishing 40% of bacterial sepsis infections. After confirmatory diagnosis, over half of sepsis patients undergo a change in antibiotic therapy. This report provides quantitative, objective data captured by hospitals contributing to Cerner Health Facts. This data provides real-world patient encounters and reflects real physician decisions and encounter characteristics (e.g. patient response to therapy and outcomes) in key areas, such as antibiotic resistant pathogens and antimicrobial stewardship.

1. Boston Strategic Partners, Inc.
Business and Clinical Strategy ● Health Economics & Outcomes Research
Medical Communications ● Regulatory Strategy ● Financial Advisory
4 Wellington St. Suite 3, Boston, MA 02118 ● http://www.bostonsp.com ● realworldreports@bostonsp.com ● 617-446-3440
Real World Insights: Hospital-Treated Sepsis
July 2017

2. Abstract
In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an
Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+
hospitals across the US, Boston Strategic Partners (BSP) estimates 30% of all hospital discharges involve treatment of infectious organisms.
Sepsis is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that
hospitalizations for severe infections account for $212 billion in annual spending or 7% of total healthcare expenditure. In this report, we
conduct an in-depth analysis of Sepsis patient characteristics, medication management, costs, and laboratory testing.
Gram-positive bacteria are the likely causative agents of most Sepsis infections. Physicians treat the vast majority of these infections with
vancomycin, piperacillin-tazobactam, levofloxacin, and ceftriaxone. From 2010-2015, drug resistant organisms caused an astonishing 40% of
bacterial Sepsis infections. After confirmatory diagnosis, over half of Sepsis patients undergo a change in antibiotic therapy.
This report provides quantitative, objective data focused on Sepsis infections requiring hospitalization captured by hospitals contributing to
Cerner Health Facts. This data provides real-world patient encounters and reflects real physician decisions and encounter characteristics (e.g.
patient response to therapy and outcomes) in key areas, such as antibiotic resistant pathogens and antimicrobial stewardship.
• Focused on Sepsis requiring hospitalization, detailed analysis of over 680K hospital discharges from 2009 to 2015 (including projections
through 2019)
• Epidemiology of infection in the US, including demographic information, growth, overall patient encounter attributes, and most common
causative agents
• An overview of patients with Sepsis in the US, including region, gender, and age breakdown, payer type, infection type, associated patient
comorbidities, and antibiotic usage
• Analysis of Length of Stay (LOS), mortality, total costs, and admission data and how they correlate with the following:
• Age of patient
• APACHE II score
• Care setting
• Antibiotic usage
• Examination of frequently ordered lab tests and cultures with data on turnaround time (TAT) and results
• Assessment of confirmatory diagnostic results, empiric therapy, and how results impact empiric therapy
• Treatment duration of frequently used antibiotics
• Discussion of the increasing concern regarding antibiotic-resistant organisms
• Growth
• Costs
• Outcomes
• LOS
2

3. Table of Contents
3
1. Outline
2. Executive Summary
3. Incidence and Impact of Disease
a. Incidence
b. Length of Stay
c. Total Cost
4. Patient Demographics
a. Age
b. Insurance type
c. Gender
d. Region
e. Mortality
f. Comorbid Conditions
5. Patient Segmentation by Diagnostic Testing
a. Causative Etiologic Agent
6. Length of Stay and Cost by Patient Segment
a. Age at Admission
b. APACHE II Score
c. First Care Setting
7. Patient Flow through the Hospital
a. Admission Site
b. Lab Testing
c. Lab TAT
d. Results
e. Etiology
f. Empiric Therapy
g. Change in treatment
8. Drug Share for Key Therapeutics
a. Most Common
b. LOS
c. APACHE Score
d. Treatment Duration
e. Product Dashboards
i. Market Share
ii. Demographics
iii. Hospitalization
9. Outcomes of Treatment
a. Antibiotic Usage
b. Mortality
c. Cost per Patient
10. Drug Resistant Sepsis
a. Current Trends
b. Costs
c. Comorbidity
d. LOS
e. Mortality
11. Database Overview
12. Methodology

4. Executive Summary
Methodology Overview:
Using an electronic health record (EHR) database with information collected from 614 hospitals across
the US, we evaluated overall trends in the diagnosis, treatment, costs, and outcomes associated with
acute infections requiring hospitalization (n=681,251 patients from 2010-2015). In addition, we
conducted an in-depth analysis for specific types of infections. This report will focus on the treatment
of Sepsis in the hospital.
Incidence and Impact of Disease:
In 2014, the US healthcare spending crossed $3.0 trillion with nearly 1/3 ($971 billion) spent on
hospitalizations.1 In 2013, an estimated 13.7 million hospital discharges (~30% of all hospital
discharges) involved treatment of infectious organisms.2
At an average cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections
account for approximately $212 billion in annual spending (7% of total healthcare expenditure).
Sepsis accounts for approximately 1.15 MM inpatient stays per year, or ~12% of all hospital stays. Of
these patients, approximately 33% have confirmed bacterial agents as the cause of infection.
4
Source: CMS, 2016, HCUP, 2016, BSP EHR database

5. Market Share of Piperacillin-tazobactam
Piperacillin-tazobactam Dashboard
5
14.30%
Demographics Hospitalization
Median
APACHE II
Score
Gender
Breakdown
Mortality Rate
Median Length
of Stay
AWP Per Dose
Median
Number of
Doses
Duration of
Treatment per
Patient
IV
3.375 g:
$13.20 - $21.75
4.5 g:
$17.60 - $27.55
27 doses per
visit
3.3 Days
Rank*: 11th
7.0
49.0% Female
51.0% Male
11%
6.8 Days
Rank: T-9th
Source: BSP EHR database (2010 – 2015), RedBook, 2016, Sanford Guide to Antimicrobial Therapy, 2009
*Shortest duration has highest rank
1-9, 0.1% 10-19,
0.4%
20-29,
2.9%
30-39,
5.4%
40-49,
10.8%
50-59,
16.0%
60-69,
21.1%
70-79,
20.4%
80-89,
19.0%
90-99,
3.9%
100+, 0.1%
Drug

6. The dataset represents 10% of US hospitals and 16% of the US population
with data from over 273MM patient visits
6
Pacific
Hospitals: 43 (7%)
Visits: 23.2 MM
Patients: 4.6 MM (9%)
Mountain
Hospitals: 58 (11%)
Visits: 11.9 MM
Patients: 1.8 MM (8%)
West North Central
Hospitals: 83 (11%)
Visits: 41.5 MM
Patients: 6.5 MM (31%)
East North Central
Hospitals: 80 (9%)
Visits: 19.9 MM
Patients: 3.8 MM (8%)
West South Central
Hospitals: 58 (6%)
Visits: 15.8 MM
Patients: 3.2 MM (8%)
New England
Hospitals: 24 (10%)
Visits: 30.3 MM
Patients: 2.9 MM (19%)
Mid Atlantic
Hospitals: 95 (19%)
Visits: 84.6 MM
Patients: 16.1 MM (39%)
South Atlantic
Hospitals: 42 (5%)
Visits: 7.7 MM
Patients: 1.8 MM (3%)
East South Central
Hospitals: 110 (23%)
Visits: 37.8 MM
Patients: 8.9 MM (47%)
Dataset (% of total US market)
Overall
614 Hospitals
273 MM Patient Visits
56 MM Unique Patients
January 2000 – March 2015
Source: BSP EHR database, HCUP, US Census