[Expensive modern therapy options in intensive care medicine in Germany-- are they being used? Results of a questionnaire].
BACKGROUND
The use of new, high-priced therapies in intensive care medicine should be assessed by a questionnaire.


METHODS
Questionnaires were sent to 849 intensive care units in Germany. The use of three new strategies were asked: treatment of methicilline resistant staphylococcus aureus (MRSA) patients (using linezolid), of severe bleeding (using rFVIIa), and of severe sepsis (using activated protein C [aPC]).


RESULTS
Approximately 39 % of the questionnaires were answered and analyzed. All three new strategies were only rarely or very rarely used in Germany even in universities and hospitals with more than 1000 beds. This appears to be very astonishing because all substances were subject to extensive marketing campaigns, received scientific prices (linezolid) or were strongly recommended by some scientific societies (aPC). One major concern to the use of the new approaches was based on the high pricing. Prices were assessed as excessive or very excessive. In spite of a mass of information about the substances, a lot of the intensivists reviewed the scientific basis as weak and not justifying the use of the costly substances.


CONCLUSIONS
Modern, costly pharmaceutical approaches in intensive care medicine are widely not accepted in Germany. Especially a tight financial corset hinders most intensivists to use these strategies that may be life-saving in some patients. A solution to this problem is urgently required that can be reached only in intensive exchange with all who are responsible for this dilemma.
Boldt
J
J
Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen. BoldtJ@gmx.net
Papsdorf
M
M
D000081:Acetamides / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care / Q000191:economics*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data*; D015942:Factor VIIa / Q000191:economics / Q000627:therapeutic use; D005858:Germany; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000639:trends; D000069349:Linezolid; D016106:Methicillin Resistance; D023303:Oxazolidinones / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D011486:Protein C / Q000191:economics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects; D011795:Surveys and Questionnaires
D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D011486:Protein C; D011994:Recombinant Proteins; D015942:Factor VIIa; D000069349:Linezolid; C421124:drotrecogin alfa activated