title: The cost-effectiveness ratio of a managed protocol for severe sepsis.
abstract: OBJECTIVE
  Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis.
  
  
  METHODS
  This is a prospective cohort study involving a historical comparison (before and after the implementation of the protocol) of patients who had been hospitalized with severe sepsis and septic shock. The group of patients who were treated before the assistance routine was implemented was considered to be the control. The case-managed nurse involved with assistance protocol performed the data collection. This nurse received special training to ensure the quality of the data and to measure the intervention throughout the implementation process.
  
  
  RESULTS
  A total of 414 patients were analyzed. The mortality rates were 57% in the control group and 38% in the protocol group (P=.002). After the implementation of the protocol, the absolute risk reduction was 18%; and the relative risk reduction was 31.8%. There was a tendency for a reduction in the cost of the full hospitalization, but this trend did not reach statistical significance. Nevertheless, the cost of hospitalization in the intensive care unit was reduced significantly from US $138,237±$202,418 in the control group to US $85,484±$127,471 in the protocol group (P=.003). The managed protocol for sepsis resulted in an average gain of 3.2 life-years after being discharged from the hospital (8.8±13.3 years in the control group and 12.0±14.0 years in the protocol group, P=.01).
  
  
  CONCLUSIONS
  Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.
authors.affiliation: Department of Critically Ill Patient, Intensive Care Unit, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Sao Paulo (SP), Brazil 05652-000. Electronic address: santucci@einstein.br.
authors.forename: Murillo Santucci Cesar
authors.initials: MS
authors.lastname: Assuncao
authors.affiliation: MedInsight, Decisions in Health Care, Rio de Janeiro, Brazil. Electronic address: vanessateich@medinsight.com.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Teich
authors.affiliation: Department of Critically Ill Patient, Intensive Care Unit, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Sao Paulo (SP), Brazil 05652-000. Electronic address: sandralima@einstein.br.
authors.forename: Sandra Christina Pereira Lima
authors.initials: SC
authors.lastname: Shiramizo
authors.affiliation: Department of Internal Medicine, Medical Sciences School, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: denizarvianna@gmail.com.
authors.forename: Denizart Vianna
authors.initials: DV
authors.lastname: Araújo
authors.affiliation: Department of Critically Ill Patient, Intensive Care Unit, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Sao Paulo (SP), Brazil 05652-000.
authors.forename: Renato Melli
authors.initials: RM
authors.lastname: Carrera
authors.affiliation: Department of Critically Ill Patient, Intensive Care Unit, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Sao Paulo (SP), Brazil 05652-000. Electronic address: aryserpa@terra.com.br.
authors.forename: Ary
authors.initials: A
authors.lastname: Serpa Neto
authors.affiliation: Department of Critically Ill Patient, Intensive Care Unit, Hospital Israelita Albert Einstein, Av Albert Einstein, 627/701, Sao Paulo (SP), Brazil 05652-000. Electronic address: eliezer@einstein.br.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
mesh_terms: D018806:APACHE; D000368:Aged; D001938:Brazil; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy; D018709:Statistics, Nonparametric
keywords: Cost-effectiveness analysis; Outcome; Protocol; Sepsis; Septic shock; Severe sepsis