CONTEXT: Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. OBJECTIVE: To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. DESIGN: Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. SETTING: Beth Israel Deaconess Medical Center. PATIENTS: Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. INTERVENTIONS: An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. MAIN OUTCOME MEASURES: In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. RESULTS: Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. CONCLUSIONS: In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.
CONTEXT: Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. OBJECTIVE: To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. DESIGN: Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. SETTING: Beth Israel Deaconess Medical Center. PATIENTS: Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. INTERVENTIONS: An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. MAIN OUTCOME MEASURES: In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. RESULTS: Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. CONCLUSIONS: In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.
Authors: Romain Hernu; Martin Cour; Sylvie de la Salle; Dominique Robert; Laurent Argaud Journal: Intensive Care Med Date: 2015-05-22 Impact factor: 17.440
Authors: Marcus J Schultz; Martin W Dunser; Arjen M Dondorp; Neill K J Adhikari; Shivakumar Iyer; Arthur Kwizera; Yoel Lubell; Alfred Papali; Luigi Pisani; Beth D Riviello; Derek C Angus; Luciano C Azevedo; Tim Baker; Janet V Diaz; Emir Festic; Rashan Haniffa; Randeep Jawa; Shevin T Jacob; Niranjan Kissoon; Rakesh Lodha; Ignacio Martin-Loeches; Ganbold Lundeg; David Misango; Mervyn Mer; Sanjib Mohanty; Srinivas Murthy; Ndidiamaka Musa; Jane Nakibuuka; Ary Serpa Neto; Mai Nguyen Thi Hoang; Binh Nguyen Thien; Rajyabardhan Pattnaik; Jason Phua; Jacobus Preller; Pedro Povoa; Suchitra Ranjit; Daniel Talmor; Jonarthan Thevanayagam; C Louise Thwaites Journal: Intensive Care Med Date: 2017-03-27 Impact factor: 17.440
Authors: Greg Martin; Frank M Brunkhorst; Jonathan M Janes; Konrad Reinhart; David P Sundin; Kassandra Garnett; Richard Beale Journal: Crit Care Date: 2009-06-30 Impact factor: 9.097
Authors: R Beale; K Reinhart; F M Brunkhorst; G Dobb; M Levy; G Martin; C Martin; G Ramsey; E Silva; B Vallet; J-L Vincent; J M Janes; S Sarwat; M D Williams Journal: Infection Date: 2009-04-28 Impact factor: 3.553
Authors: Margaret S Herridge; Marc Moss; Catherine L Hough; Ramona O Hopkins; Todd W Rice; O Joseph Bienvenu; Elie Azoulay Journal: Intensive Care Med Date: 2016-03-30 Impact factor: 17.440