The cost-effectiveness ratio of a managed protocol for severe sepsis

• Published in: Journal of critical care 2014-08, Vol.29 (4), p.692.e1-692.e6
• Main Authors: Assuncao, Murillo Santucci Cesar, MD, MSC, Teich, Vanessa, BSc, Shiramizo, Sandra Christina Pereira Lima, RN, Araújo, Denizart Vianna, MD, Carrera, Renato Melli, MD, Serpa Neto, Ary, MD, MSC, Silva, Eliezer, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Antibiotics; APACHE; Brazil; Case-Control Studies; Chi-Square Distribution; Clinical Protocols; Controlled Before-After Studies; Cost-Benefit Analysis; Cost-effectiveness analysis; Costs; Critical Care; Critical Care - economics; Developing countries; Emergency medical care; Female; Glucose; Hospitalization; Hospitalization - economics; Hospitals; Humans; Intensive Care Units - economics; LDCs; Life expectancy; Male; Middle Aged; Mortality; Outcome; Patients; Physicians; Prospective Studies; Protocol; Sepsis; Sepsis - mortality; Sepsis - therapy; Septic shock; Severe sepsis; Shock, Septic - mortality; Shock, Septic - therapy; Standard deviation; Statistics, Nonparametric; Variables; Ventilation
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.03.008

Abstract Purpose Severe sepsis is a time-dependent disease, and implementation of early treatment has been associated with mortality rate reduction. However, the literature is controversial regarding cost-effectiveness analysis of this intervention. The aim was to assess the cost-effectiveness of a managed protocol for the treatment of severe sepsis. Materials and methods This is a prospective cohort study involving a historical comparison (before and after the implementation of the protocol) of patients who had been hospitalized with severe sepsis and septic shock. The group of patients who were treated before the assistance routine was implemented was considered to be the control. The case-managed nurse involved with assistance protocol performed the data collection. This nurse received special training to ensure the quality of the data and to measure the intervention throughout the implementation process. Results A total of 414 patients were analyzed. The mortality rates were 57% in the control group and 38% in the protocol group ( P = .002). After the implementation of the protocol, the absolute risk reduction was 18%; and the relative risk reduction was 31.8%. There was a tendency for a reduction in the cost of the full hospitalization, but this trend did not reach statistical significance. Nevertheless, the cost of hospitalization in the intensive care unit was reduced significantly from US $138,237 ± $202,418 in the control group to US $85,484 ± $127,471 in the protocol group ( P = .003). The managed protocol for sepsis resulted in an average gain of 3.2 life-years after being discharged from the hospital (8.8 ± 13.3 years in the control group and 12.0 ± 14.0 years in the protocol group, P = .01). Conclusions Given that the incremental cost was lower than or equal to zero, the effectiveness of the protocol was justified by the significant increase in the life-years saved and the reduced mortality.