title: Cost-effectiveness of an emergency department-based early sepsis resuscitation protocol.
abstract: OBJECTIVE
  Guidelines recommend that sepsis be treated with an early resuscitation protocol such as early goal-directed therapy. Our objective was to assess the cost-effectiveness of implementing early goal-directed therapy as a routine protocol.
  
  
  METHODS
  Prospective before and after study.
  
  
  METHODS
  Large urban hospital emergency department with >110,000 visits/yr.
  
  
  METHODS
  The target population was patients with consensus criteria for septic shock. We excluded those with age <18 yrs, no aggressive care desired, or need for immediate surgery.
  
  
  METHODS
  Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before; and 2) 2 yrs after implementing early goal-directed therapy as standard of care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were 1-yr mortality, discounted life expectancy, and quality-adjusted life-years. Using costs and quality-adjusted life-years, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a quality-adjusted life-year.
  
  
  RESULTS
  Two hundred eighty-five subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with early goal-directed therapy was associated with an increased hospital cost of $7,028 and an increase in both discounted sepsis-adjusted life expectancy and quality-adjusted life years of 1.5 and 1.3 yrs, respectively. Early goal-directed therapy use was associated with a cost of $5,397 per quality-adjusted life-years gained and the net monetary benefit analysis indicates a 98% probability (p = .038) that early goal-directed therapy is cost-effective at a willingness to pay of $50,000 per quality-adjusted life-years.
  
  
  CONCLUSIONS
  Implementation of early goal-directed therapy in the emergency department care of patients with severe sepsis is cost-effective.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. alan.jones@carolinas.org
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Troyer
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012151:Resuscitation / Q000191:economics*; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D059039:Standard of Care / Q000191:economics*; D015996:Survival Rate; D016896:Treatment Outcome