Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis.
OBJECTIVE
To assess the cost-effectiveness of drotrecogin alfa (activated) therapy, which was recently shown to reduce mortality in severe sepsis.


METHODS
Estimates of effectiveness and resource use were based on data collected prospectively as part of a multicenter international trial. Estimates of hospital costs were based on a subset of the patients treated in the United States (33% of all enrolled patients). Lifetime projections were modeled from published sources and tested in sensitivity analyses. Analyses were conducted from the United States societal perspective, limited to healthcare costs, and using a 3% annual discount rate.


METHODS
A total of 164 medical institutions in 11 countries.


METHODS
Adults > or = 18 yrs of age with severe sepsis


METHODS
Eligible patients were randomly assigned to receive a 96-hr intravenous infusion of drotrecogin alfa (activated) at 24 microg/kg/hr (n = 850) or placebo (n = 840).


RESULTS
Base Case: incremental short-term (days 1-28) healthcare costs per day-28 survivor; Panel on Cost-Effectiveness in Health and Medicine Reference Case: incremental lifetime healthcare costs per quality-adjusted life-year. Over the first 28 days (short-term Base Case), drotrecogin alfa (activated) increased the costs of care by $9,800 and survival by 0.061 lives saved per treated patient. Thus, drotrecogin alfa (activated) cost $160,000 per life saved (with 84.7% probability that ratio is <$250,000 per life saved). Projected to lifetime (lifetime Reference Case), drotrecogin alfa (activated) increased the costs of care by $16,000 and quality-adjusted survival by 0.33 quality-adjusted life-years per treated patient. Thus, drotrecogin alfa (activated) cost $48,800 per quality-adjusted life-year (with 82% probability that ratio is <$100,000 per quality-adjusted life-year). Estimates were generally robust to sensitivity analyses, although cost-effectiveness deteriorated to >$100,000 per quality-adjusted life-year if survivors lived <4.6 yrs on average. Drotrecogin alfa (activated) cost $27,400 per quality-adjusted life-year when limited to patients with an Acute Physiology and Chronic Health Evaluation II score > or = 25 and was cost-ineffective when limited to patients with a score <25.


CONCLUSIONS
Drotrecogin alfa has a cost-effectiveness profile similar to that of many well-accepted healthcare strategies and below commonly quoted thresholds.
Angus
Derek C
DC
Department of Critical Care Medicine, Clinical Research, Investigation and Systems Modeling of Acute Illness Laboratory, University of Pittsburgh, PA 15213, USA. angusdc@ccm.upmc.edu
Linde-Zwirble
Walter T
WT
Clermont
Gilles
G
Ball
Daniel E
DE
Basson
Bruce R
BR
Ely
E Wesley
EW
Laterre
Pierre-Francois
PF
Vincent
Jean-Louis
JL
Bernard
Gordon
G
van Hout
Ben
B
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011486:Protein C / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics* / Q000627:therapeutic use; D012306:Risk; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated