Early goal-directed therapy (EGDT) for severe sepsis and septic shock has been shown to significantly decrease 60 day mortality and survivor hospital length of stay . However, concern exists over the additional resources and personnel required for this labor-intensive therapy.
We conducted a cost-effectiveness analysis of EGDT from the US societal perspective, based on the results of a recent randomized trial . In constructing the reference case, estimates of short-term effectiveness were based on 60 day survival. Short-term costs were estimated from mechanical ventilation duration, hospital length of stay, and the additional requirements for blood, personnel and capital costs of EGDT. We estimated long-term survival from prior observational data in sepsis patients and long-term costs using age-specific annual health care costs from the National Center of Health Statistics' Medical Expenditure Survey and published costs of nursing homes.
The incremental cost-effectiveness ratio (ICER) of EGDT over standard care was $25,600/QALY (quality-adjusted life-year) (95% CI: $20,500–78,600/QALY). In multiway sensitivity analyses, 94% of simulations had an ICER below $50,000/QALY. EGDT was cost-effective (< $50,000/QALY) as long as patient volume exceeded 16/year. Cost-effectiveness increased with greater annual patient volume, decreased long-term survival, decreased annual health care costs, and decreased capital costs. EGDT remained cost-effective even if its 60 day mortality effectiveness was only 20% of that reported by Rivers et al.  (Fig. 1).
EGDT is cost-effective for severe sepsis and septic shock over a wide range of assumptions.
Sponsored by NIH grant 02-T32HL07820-06.