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.

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.

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).