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This article is part of the supplement: 23rd International Symposium on Intensive Care and Emergency Medicine

Meeting abstract

Cost-effectiveness of early goal-directed therapy in the treatment of severe sepsis and septic shock

DT Huang1, DC Angus1, TT Dremsizov1, EP Rivers2 and G Clermont1

Author Affiliations

1 CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA

2 Departments of Emergency Medicine and Surgery, Henry Ford Hospital, Case Western Reserve University, Detroit, MI, USA

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Critical Care 2003, 7(Suppl 2):P232 doi:10.1186/cc2121


The electronic version of this article is the complete one and can be found online at:


Published:3 March 2003

©

Introduction

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 [1]. However, concern exists over the additional resources and personnel required for this labor-intensive therapy.

Methods

We conducted a cost-effectiveness analysis of EGDT from the US societal perspective, based on the results of a recent randomized trial [1]. 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.

Results

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. [1] (Fig. 1).

thumbnailFigure 1.

Discussion

EGDT is cost-effective for severe sepsis and septic shock over a wide range of assumptions.

Acknowledgement

Sponsored by NIH grant 02-T32HL07820-06.

References

  1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, for the Early Goal-Directed Therapy Collaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock.

    N Engl J Med 2001, 345:1368-1377. PubMed Abstract | Publisher Full Text OpenURL