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

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).

Figure 1

Discussion

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