CONTEXT: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown. OBJECTIVE: To determine the cost-effectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis. DESIGN: Observational prospective before-and-after study. SETTING: 59 medical-surgical intensive care units located throughout Spain. PATIENTS: A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the post-educational program cohort (SSC protocol care of severe sepsis). INTERVENTIONS: The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions. MAIN OUTCOME MEASURES: Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER). RESULTS: Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114-3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02-1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG. CONCLUSION: The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.
CONTEXT: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown. OBJECTIVE: To determine the cost-effectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis. DESIGN: Observational prospective before-and-after study. SETTING: 59 medical-surgical intensive care units located throughout Spain. PATIENTS: A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the post-educational program cohort (SSC protocol care of severe sepsis). INTERVENTIONS: The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions. MAIN OUTCOME MEASURES: Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER). RESULTS:Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114-3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02-1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG. CONCLUSION: The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.
Authors: Derek C Angus; Walter T Linde-Zwirble; Gilles Clermont; Daniel E Ball; Bruce R Basson; E Wesley Ely; Pierre-Francois Laterre; Jean-Louis Vincent; Gordon Bernard; Ben van Hout Journal: Crit Care Med Date: 2003-01 Impact factor: 7.598
Authors: Ricard Ferrer; Antonio Artigas; Mitchell M Levy; Jesús Blanco; Gumersindo González-Díaz; José Garnacho-Montero; Jordi Ibáñez; Eduardo Palencia; Manuel Quintana; María Victoria de la Torre-Prados Journal: JAMA Date: 2008-05-21 Impact factor: 56.272
Authors: R Phillip Dellinger; Jean M Carlet; Henry Masur; Herwig Gerlach; Thierry Calandra; Jonathan Cohen; Juan Gea-Banacloche; Didier Keh; John C Marshall; Margaret M Parker; Graham Ramsay; Janice L Zimmerman; Jean-Louis Vincent; M M Levy Journal: Intensive Care Med Date: 2004-03-03 Impact factor: 17.440
Authors: Mitchell M Levy; R Phillip Dellinger; Sean R Townsend; Walter T Linde-Zwirble; John C Marshall; Julian Bion; Christa Schorr; Antonio Artigas; Graham Ramsay; Richard Beale; Margaret M Parker; Herwig Gerlach; Konrad Reinhart; Eliezer Silva; Maurene Harvey; Susan Regan; Derek C Angus Journal: Intensive Care Med Date: 2010-01-13 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: R P Dellinger; Mitchell M Levy; Andrew Rhodes; Djillali Annane; Herwig Gerlach; Steven M Opal; Jonathan E Sevransky; Charles L Sprung; Ivor S Douglas; Roman Jaeschke; Tiffany M Osborn; Mark E Nunnally; Sean R Townsend; Konrad Reinhart; Ruth M Kleinpell; Derek C Angus; Clifford S Deutschman; Flavia R Machado; Gordon D Rubenfeld; Steven Webb; Richard J Beale; Jean-Louis Vincent; Rui Moreno Journal: Intensive Care Med Date: 2013-01-30 Impact factor: 17.440
Authors: Massimo Antonelli; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; J Randall Curtis; Daniel De Backer; Goran Hedenstierna; Michael Joannidis; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Jean-Charles Preiser; Patricia Rocco; Jean-François Timsit; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2012-01-20 Impact factor: 17.440
Authors: Ana Díaz-Martín; María Luisa Martínez-González; Ricard Ferrer; Carlos Ortiz-Leyba; Enrique Piacentini; Maria Jesus Lopez-Pueyo; Ignacio Martín-Loeches; Mitchell M Levy; Antoni Artigas; José Garnacho-Montero Journal: Crit Care Date: 2012-11-18 Impact factor: 9.097