Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-25T20:57:22.245Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis with multiple organ failure

Published online by Cambridge University Press:  27 February 2006

Lionel Riou França ,
Robert Launois ,
Katell Le Lay ,
Philippe Aegerter ,
Myriam Bouhassira ,
Patrick Meshaka  and
Bertrand Guidet
Lionel Riou França
Affiliation:
REES France
Robert Launois
Affiliation:
University of Paris XIII and REES France
Katell Le Lay
Affiliation:
REES France
Philippe Aegerter
Affiliation:
INSERM U707 and Ambroise Paré Hospital
Myriam Bouhassira
Affiliation:
Lilly France
Patrick Meshaka
Affiliation:
Lilly France
Bertrand Guidet
Affiliation:
INSERM U707 and Saint Antoine Hospital
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to estimate the expected cost and clinical benefits associated with the use of drotrecogin alfa (activated) (Xigris; Eli Lilly and Company; Indianapolis, IN) in the French hospital setting.

Methods: The recombinant human activated PROtein C Worldwide Evaluation in Severe Sepsis (PROWESS) study results (1,271 patients with multiple organ failure) were adjusted to 9,948 hospital stays from a database of Parisian area intensive-care units (ICUs)—the CubRea (Intensive Care Database User Group) database. The analysis features a decision tree with a probabilistic sensitivity analysis.

Results: The cost per life year gained (LYG) of drotrecogin treatment for severe sepsis with multiple organ failure (European indication) was estimated to be $11,812. At the hospital level, the drug is expected to induce an additional cost of $7,545 per treated patient. The incremental cost-effectiveness ratio ranges from $7,873 per LYG for patients receiving three organ supports during ICU stay to $17,704 per LYG for patients receiving less than two organ supports.

Conclusions: Drotrecogin alfa (activated) is cost-effective in the treatment of severe sepsis with multiple organ failure when added to best standard care. The cost-effectiveness of the drug increases with baseline disease severity, but it remains cost-effective for all patients when used in compliance with the European approved indication.

Keywords

Severe sepsisIntensive careDrotrecogin alfa (activated)Cost-effectivenessHealth care costs
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 1 , January 2006 , pp. 101 - 108
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alberti C, Brun-Buisson C, Goodman SV, et al. 2003 European Sepsis Group. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Crit Care Med. 168: 77– 84.Google Scholar
Angus DC Linde-Zwirble WT, Clermont G, et al. 2003 Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis. Crit Care Med. 31: 1– 11.Google Scholar
Angus DC, Linde-Zwirble WT, Lidicker J, et al. 2001 Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 29: 1303– 1310.Google Scholar
Bernard GR, Vincent JL, Laterre PF, et al. 2001 Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 344: 699– 709.Google Scholar
Bone RC, Balk RA, Cerra FB, et al. 1992 Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 101: 1644– 1655.Google Scholar
Briggs AH. 2000 Handling uncertainty in cost-effectiveness models. Pharmacoeconomics. 17: 479– 500.Google Scholar
Brun-Buisson C, Doyon F, Carlet J, et al. 1995 Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA. 274: 968– 974.Google Scholar
Brun-Buisson C, Meshaka P, Pinton P, et al. 2004 EPISEPSIS: A reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units. Intensive Care Med. 30: 580– 588.Google Scholar
Brun-Buisson C, Roudot-Thoraval F, Girou E, et al. 2003 The costs of septic syndromes in the intensive care unit and influence of hospital-acquired sepsis. Intensive Care Med. 29: 1464– 1471.Google Scholar
Buxton MJ, Drummond MF, Van Hout BA, et al. 1997 Modeling in economic evaluation: An unavoidable fact of life. Health Econ. 6: 217– 227.Google Scholar
1997. Canadian Coordinating Office for Health Technology Assessment. Guidelines for economic evaluation of pharmaceuticals: Canada. 2nd ed. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA);
Chaix C, Durand-Zaleski I, Alberti C, et al. 1999 A model to compute the medical cost of patients in intensive care. Pharmacoeconomics. 15: 573– 582.Google Scholar
Coulomb F, Moret L, Boudon M, et al. 2000 La classification médico-économique SRLF-SFAR-Image est applicable à un service de réanimation polyvalente d'un centre hospitalier général. Réan Urg. 9: 241– 247.Google Scholar
Coyle D, Tolley K. 1992 Discounting of health benefits in the pharmacoeconomic analysis of drug therapies: An issue for debate? Pharmacoeconomics. 2: 153– 162.Google Scholar
Dhainaut JF, Laterre PF, Janes JM, et al. 2003 Drotrecogin alfa (activated) in the treatment of severe sepsis patients with multiple-organ dysfunction: Data from the PROWESS trial. Intensive Care Med. 29: 894– 903.Google Scholar
Doubilet P, Begg CB, Weinstein MC, et al. 1985 Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 5: 157– 177.Google Scholar
Gastinne H, Raffy C, Richard V, et al. 2000 Les groupes homogènes de malades proposés pour la réanimation. Etude de la pertinence de cette classification basée sur un calcul de coûts. Réan Urg. 9: 249– 256.Google Scholar
Gold MR, Siegel J, Russell L, et al. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press;
Granja C, Teixeira-Pinto A, Costa-Pereira A. 2002 Quality of life after intensive care-evaluation with EQ-5D questionnaire. Intensive Care Med. 28: 898– 907.Google Scholar
Hurel D, Loirat P, Saulnier F, et al. 1997 Quality of life 6 months after intensive care: Results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med. 23: 331– 337.Google Scholar
Knaus WA, Draper EA, Wagner DP, et al. 1985 APACHE II: A severity of disease classification system. Crit Care Med. 13: 818– 829.Google Scholar
Laupacis A, Feeny D, Detsky AS, et al. 1992 How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J. 146: 473– 481.Google Scholar
Le Gall JR, Lemeshow S, Leleu G, et al. 1995 Customized probability models for early severe sepsis in adult intensive care. patients. Intensive Care Unit Scoring Group. JAMA. 273: 644– 650.Google Scholar
Le Gall JR, Lemeshow S, Saulnier F. 1993 A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 270: 2957– 2963.Google Scholar
Letarte J, Longo CJ, Pelletier J, et al. 2002 Patient characteristics and costs of severe sepsis and septic shock in Quebec. J Crit Care. 17: 39– 49.Google Scholar
Manns BJ, Lee H, Doig CJ, et al. 2002 An economic evaluation of activated protein C treatment for severe sepsis. N Engl J Med. 347: 993– 1000.Google Scholar
McCabe WR, Jackson GG. 1962 Gram negative bacteremia I: Etiology an ecology. Arch Intern Med. 110: 847– 855.Google Scholar
McNelis J, Marini C, Kalimi R, et al. 2001 A comparison of predictive outcomes of APACHE II and SAPS II in a surgical intensive care unit. Am J Med Qual. 16: 161– 165.Google Scholar
Misset B, Naiditch M, Saulnier F, et al. 1998 Construction d'une classification médico-économique des patients de réanimation fondée sur les suppléances d'organes. Réan Urg. 7: 367– 374.Google Scholar
Moerer O, Schmid A, Hofmann M, et al. 2002 Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med. 28: 1440– 1446.Google Scholar
Neilson AR, Burchardi H, Chinn C, et al. 2003 Cost-effectiveness of drotrecogin alfa (activated) for the treatment of severe sepsis in Germany. J Crit Care. 18: 217– 227.Google Scholar
Neyman J, Pearson ES. 1933 On the problem of the most efficient tests of statistical hypotheses. Philos Trans R Soc Lond. A231: 289– 337.Google Scholar
Pittet D, Rangel-Frausto S, Li N, et al. 1995 Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med. 21: 302– 309.Google Scholar
Quartin AA, Schein RM, Kett DH, et al. 1997 Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA. 277: 1058– 1063.Google Scholar
Schechtman E. 2002 Odds ratio, relative risk, absolute risk reduction, and the number needed to treat-which of these should we use? Value Health. 5: 430– 435.Google Scholar
Schmid A, Pugin J, Chevrolet JC, et al. 2004 Burden of illness imposed by severe sepsis in Switzerland. Swiss Med Wkly. 134: 97– 102.Google Scholar
Sznajder M, Aegerter P, Launois R, et al. 2001 CubRea. A cost-effectiveness analysis of stays in intensive care units. Intensive Care Med. 27: 146– 153.Google Scholar
Sznajder M, Leleu G, Buonamico G, et al. 1998 Estimation of direct cost and resource allocation in intensive care: Correlation with Omega system. Intensive Care Med. 24: 582– 589.Google Scholar
Taheri PA, Butz DA, Greenfield LJ. 2000 Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg. 191: 123– 130.Google Scholar
Tengs TO, Adams ME, Pliskin JS, et al. 1995 Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal. 15: 369– 390.Google Scholar
Van Hout BA, Al MJ, Gordon GS, et al. 1994 Costs, effects and C/E-ratios alongside a clinical trial. Health Econ. 3: 309– 319.Google Scholar
Weibull WA. 1939 A statistical theory of the strength of materials. Ingenoirs Vetenskaps Akadanien Handlinger. 151: 1– 45.Google Scholar
Weinstein MC, O'Brien B, Hornberger J, et al. 2003 ISPOR Task force on good research practices–Modeling studies. Value Health. 6: 9– 17.Google Scholar