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PharmacoEconomics
Published in: PharmacoEconomics 18/2003

01-12-2003 | Original Research Article

An evaluation of the cost effectiveness of drotrecogin alfa (activated) relative to the number of organ system failures

Authors: Madeline Betancourt, Peggy S. McKinnon, R. Michael Massanari, Salmaan Kanji, David Bach, John W. Devlin

Published in: PharmacoEconomics | Issue 18/2003

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Abstract

Background: While drotrecogin alfa (activated) was shown to decrease absolute 28-day mortality by 6.1% in patients with severe sepsis in the Recombinant Human Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study, no mortality benefit was observed in the subset of patients with only one organ system failure. Consequently, some institutions restrict drotrecogin alfa (activated) use to patients with severe sepsis with ≥ organ system failures.
Objective: To measure the cost effectiveness of drotrecogin alfa (activated) for treatment of severe sepsis in relation to the number of organ system failures and determine the economic impact of restricting drotrecogin alfa (activated) use based on the number of organ system failures.
Perspective: Policy perspective specific to our 340-bed, level I trauma centre.
Methods: A Monte Carlo simulation analysis was conducted to evaluate a hypothetical cohort of 10 000 patients with severe sepsis in four scenarios restricting treatment with drotrecogin alfa (activated) to patients with ≥1, ≥2, ≥3 or ≥4 organ system failures. The primary outcomes of 28-day all-cause mortality and serious bleeding were obtained from the PROWESS study. Costs (year 2002 values) were obtained from institutional financial records and literature estimates. The incremental cost per life saved at 28 days with drotrecogin alfa (activated) plus best standard care versus best standard care alone (placebo) was calculated. The incidence of severe sepsis and number of drotrecogin alfa (activated) candidates were estimated through chart review, and projected annual institutional expenditures were derived according to these data.
Results: With increasing number of organ system failures, the proportion of lives saved with drotrecogin alfa (activated) increased, and consequently the ICER decreased. Restriction of drotrecogin alfa (activated) to patients with ≥4 organ system failures was the most cost-effective scenario (0.11 lives saved; $US56 727 per life saved). For the nine patients that would be treated annually by our institution under this policy, one life would be saved at a total additional cost of $US56 160 per year. Use of the drug in patients with ≥1 or ≥2 organ system failures would save the greatest number of lives per year (4–5); however, restricting drotrecogin alfa (activated) to patients with ≥ organ system failures would be the cheaper alternative (total additional cost $US356 022 vs $US462 204).
Conclusion: While restriction of drotrecogin alfa (activated) use to patients with sepsis with ≥4 organ system failures is the most cost-effective alternative, restriction to those with ≥2 organ system failures is the preferred alternative for our institution according to the number of lives saved and available financial resources.
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Metadata
Title
An evaluation of the cost effectiveness of drotrecogin alfa (activated) relative to the number of organ system failures
Authors
Madeline Betancourt
Peggy S. McKinnon
R. Michael Massanari
Salmaan Kanji
David Bach
John W. Devlin
Publication date
01-12-2003
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 18/2003
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/BF03262331