Modelling the cost-effectiveness of treatment of septic patients in intensive care units in Hungary

Introduction

Sepsis is among the most lethal diseases in Hungary. While there were 2659 septic events treated in intensive care units (ICU) in Hungary in 2001, 42.7% of the treated patients died owing to sepsis. Obviously, this figure calls attention to the need of measuring the effectiveness and efficiency of sepsis treatment. There is a considerable amount of information related to the effectiveness of different treatment alternatives. In our study we aimed to assess the cost-effectiveness of sepsis treatment in Hungary for the year 2001.

Methods

To calculate the average efficiency of treatment of a septic patient in an ICU in Hungary, we constructed a model. This model was made up of three parts. In the first part we defined a septic patient cohort based on the age and gender distribution of all the septic cases treated in ICUs in Hungary in 2001. This patient cohort entered into the second part of the model, where we developed a time-dependent Markov model to describe and analyse the route of Hungarian septic cases through a 28-day-long period. We defined three Markovian states: survival in the ICU, leaving the ICU or the hospital alive, and death in or out of the ICU. Transfer probabilities were defined for each of the 28 days on the basis of data collected for all septic events treated in ICUs in Hungary in 2001 (data were provided by Hungarian governmental health care information suppliers 'GYOGYINFOK'). In the third phase, patients' life-long survival was modelled based on the average age-specific life expectancy of the Hungarian population (data source: Hungarian Central Statistical Office). Survival of the septic patients was corrected by a factor of 0.51 taken from the international literature. Cost data of treatment of septic patients was collected in a nonrandom sample of six Hungarian ICUs. Microcosts of the ICU treatment of 70 septic patients were collected in 2002. Collection and analysis of cost data were described in a detailed manner in another report. Cost per years of survival was selected as a cost-effectiveness measure. During the calculation of efficiency, we used a societal and a Health Insurance Fund viewpoint.

Results

The average survival of a septic patient was 8.6 years in Hungary. The average cost of treatment was 1,036,474 HUF from a societal and 462,765 HUF from a Health Insurance Fund (HIF) viewpoint. Average cost-effectiveness of sepsis treatment was 120,458 HUF per life years saved from a societal view. The corresponding figure was 53,765 HUF per life years saved from a HIF viewpoint.

Conclusion

Considering all the factors, we found that our model can assess the efficiency of sepsis treatment in Hungary in a valid and reliable way.