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Critical Care

, 15:R228

First Online: 26 September 2011Received: 28 June 2011Revised: 16 August 2011Accepted: 23 September 2011

Abstract

IntroductionPrevious cost-effectiveness analyses CEA reported that Drotrecogin alfa DrotAA is cost-effective based on a Phase III clinical trial PROWESS. There is little evidence on whether DrotAA is cost-effective in routine clinical practice. We assessed whether DrotAA is cost-effective in routine practice for adult patients with severe sepsis and multiple organ systems failing.

MethodsThis CEA used data from a prospective cohort study that compared DrotAA versus no DrotAA control for severe sepsis patients with multiple organ systems failing admitted to critical care units in England, Wales, and Northern Ireland. The cohort study used case-mix and mortality data from a national audit, linked with a separate audit of DrotAA infusions. Re-admissions to critical care and corresponding mortality were recorded for four years. Patients receiving DrotAA n = 1,076 were matched to controls n = 1,650 with a propensity score Pscore, and Genetic Matching GenMatch. The CEA projected long-term survival to report lifetime incremental costs per quality-adjusted life year QALY overall, and for subgroups with two or three to five organ systems failing at baseline.

ResultsThe incremental costs per QALY for DrotAA were £30,000 overall, and £16,000 for the subgroups with three to five organ systems failing. For patients with two organ systems failing, DrotAA resulted in an average loss of one QALY at an incremental cost of £15,000. When the subgroup with two organ systems was restricted to patients receiving DrotAA within 24 hours, DrotAA led to a gain of 1.2 QALYs at a cost per QALY of £11,000. The results were robust to other assumptions including the approach taken to projecting long-term outcomes.

ConclusionsDrotAA is cost-effective in routine practice for severe sepsis patients with three to five organ systems failing. For patients with two organ systems failing, this study could not provide unequivocal evidence on the cost-effectiveness of DrotAA.

AbbreviationsADDRESSAdministration of Drotrecogin alfa activated in Early Stage Severe Sepsis

APACHE IIAcute Physiology and Chronic Health Evaluation II

CEAcost-effectiveness analysis

CIconfidence interval

CMPCase Mix Programme

DrotAADrotrecogin alfa activated

EMEAEuropean Medical Evaluation Agency

FDAUS Food and Drug Administration

GenMatchGenetic Matching

HRQOLhealth-related quality of life

ICERincremental cost-effectiveness ratio

ICNARCIntensive Care National Audit and Research Centre

IMscoreIntensive Care National Audit and Research Centre model physiology score

INBincremental net benefit

LOSlength of stay

PROWESSProtein C Worldwide Evaluation in Severe Sepsis

Pscorepropensity score

QALYquality-adjusted life year

RCTrandomized controlled trial.

Electronic supplementary materialThe online version of this article doi:10.1186-cc10468 contains supplementary material, which is available to authorized users.

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Autor: M Zia Sadique - Richard Grieve - David A Harrison - Brian H Cuthbertson - Kathryn M Rowan

Fuente: https://link.springer.com/



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