Impact of CytoSorb Hemoadsorption Therapy on Cost-Effectiveness and Length of Stay in Critical Care Patients: A Preliminary Study from a Swiss High-Volume Center

Background: Sepsis remains a major global health challenge, associated with high mortality, prolonged intensive care unit (ICU) stays, and disproportionate healthcare costs. CytoSorb hemoadsorption offers a potential adjunct in septic shock, but real-world cost-effectiveness data in Diagnosis-Related Group (DRG)-based systems are limited. This study aimed to evaluate the clinical and economic impact of CytoSorb therapy in ICU patients with septic shock at a high-volume Swiss tertiary care center. Methods: A retrospective observational cohort study (2020-2023) was conducted at Kantonsspital Münsterlingen. Among 246 septic shock patients, 142 received CytoSorb therapy and 104 standard care. Patients were grouped according to treatment exposure. Baseline characteristics as well as ICU course variables, including sepsis origin, Simplified Acute Physiology Score (SAPS) II, and the Nine Equivalents of Nursing Manpower Use Score (NEMS), were compared between groups. Clinical outcomes included ICU/hospital length of stay (LOS) and duration of mechanical ventilation. Economic analysis included DRG-based revenue, direct case-related hospital costs, and net financial results. Results: CytoSorb-treated patients had significantly higher SAPS II scores at baseline. Despite higher initial acuity, this group showed a significantly shorter ICU LOS (median 408.5 vs. 554.5 h; p = 0.001), reduced hospital LOS (23.5 vs. 30.0 days; p = 0.008), and lower nursing workload (>20% NEMS point reduction; p = 0.015). Survivors treated with CytoSorb had significantly shorter ventilation durations (164.0 vs. 336.0 h; p = 0.014). Total hospital costs were not significantly different between groups; however, CytoSorb patients achieved a significantly better net financial result (CHF 17,125 vs. -1930; p = 0.025), particularly in the abdominal and pneumogenic sepsis subgroups. Conclusions: This study provides the first real-world evidence for the cost-effectiveness of CytoSorb hemoadsorption in septic shock, showing reduced ICU length of stay and improved financial outcomes, without increasing treatment costs or nursing workload. These findings challenge the perception of hemoadsorption as a cost driver and highlight its potential to optimize resource use in critical care. Further multicenter studies are needed to inform reimbursement strategies and integration into sepsis treatment protocols.