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Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis.

Publication ,  Journal Article
Fowler, RA; Hill-Popper, M; Stasinos, J; Petrou, C; Sanders, GD; Garber, AM
Published in: J Crit Care
September 2003

PURPOSE: To evaluate the cost-effectiveness of recombinant human activated protein C (rhAPC) compared with usual therapy for patients with severe sepsis, and also to determine the influence that severity of illness exerts on cost-effectiveness. MATERIALS AND METHODS: We use a Markov model-based cost-effectiveness analysis of treatment strategies for patients with severe sepsis. Therapy includes treatment with either rhAPC and usual therapy, or usual therapy alone. Probabilities for clinical outcomes were obtained from a large randomized clinical trial comparing the use of rhAPC with placebo (PROWESS study) and from outcomes literature for patients with severe sepsis and its complications. Cost estimates were based on Medicare reimbursement rates, Health Care Financing Administration information and the literature. Outcome measures include life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. RESULTS: Compared with usual therapy alone, rhAPC treatment for patients with very severe sepsis (APACHE II score > or = 25) was associated with an incremental cost-effectiveness ratio of $13 493/QALY. Treatment of patients with less severe sepsis with rhAPC (APACHE II score < 25) had an incremental cost-effectiveness ratio of $403,000/QALY. For patients with very severe sepsis the incremental cost-effectiveness ratio for treatment with rhAPC remained under $30,000/QALY, over a broad range of variables, including costs of rhAPC, costs of acute care and costs and probabilities of complications of treatment. For patients with less severe sepsis, drug costs would need to fall well below current market price before achieving cost-effectiveness. A probabilistic sensitivity analysis comparing rhAPC treatment with usual therapy for patients with very severe sepsis showed that < 1% of Monte Carlo simulations had incremental cost-effectiveness ratios > $50,000/QALY. CONCLUSIONS: The use of rhAPC for the treatment of patients with very severe sepsis, as determined by APACHE II score > or = 25, appears cost-effective, while treatment of patients with APACHE II score < 25 is not cost-effective.

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Published In

J Crit Care

DOI

ISSN

0883-9441

Publication Date

September 2003

Volume

18

Issue

3

Start / End Page

181 / 191

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Sepsis
  • Recombinant Proteins
  • Quality-Adjusted Life Years
  • Protein C
  • Probability
  • Monte Carlo Method
  • Markov Chains
  • Humans
 

Citation

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ICMJE
MLA
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Fowler, R. A., Hill-Popper, M., Stasinos, J., Petrou, C., Sanders, G. D., & Garber, A. M. (2003). Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis. J Crit Care, 18(3), 181–191. https://doi.org/10.1016/j.jcrc.2003.08.009
Fowler, Robert A., Marya Hill-Popper, John Stasinos, Constantia Petrou, Gillian D. Sanders, and Alan M. Garber. “Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis.J Crit Care 18, no. 3 (September 2003): 181–91. https://doi.org/10.1016/j.jcrc.2003.08.009.
Fowler RA, Hill-Popper M, Stasinos J, Petrou C, Sanders GD, Garber AM. Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis. J Crit Care. 2003 Sep;18(3):181–91.
Fowler, Robert A., et al. “Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis.J Crit Care, vol. 18, no. 3, Sept. 2003, pp. 181–91. Pubmed, doi:10.1016/j.jcrc.2003.08.009.
Fowler RA, Hill-Popper M, Stasinos J, Petrou C, Sanders GD, Garber AM. Cost-effectiveness of recombinant human activated protein C and the influence of severity of illness in the treatment of patients with severe sepsis. J Crit Care. 2003 Sep;18(3):181–191.
Journal cover image

Published In

J Crit Care

DOI

ISSN

0883-9441

Publication Date

September 2003

Volume

18

Issue

3

Start / End Page

181 / 191

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Sepsis
  • Recombinant Proteins
  • Quality-Adjusted Life Years
  • Protein C
  • Probability
  • Monte Carlo Method
  • Markov Chains
  • Humans