Clinical effectiveness and cost-effectiveness of drotrecogin alfa (activated) (Xigris®) for the treatment of severe sepsis in adults: a systematic review and economic evaluation

Abstract

Drotrecogin alfa (activated) plus best supportive care appears clinically and cost-effective compared with best supportive care alone, in a UK cohort of severe sepsis patients, and in the subgroup of more severely affected patients with severe sepsis and multiple organ failure. The introduction of drotrecogin alfa (activated) will involve a substantial additional cost to the NHS. The treatment-eligible population in England and Wales may comprise up to 16,570 patients, with an estimated annual drug acquisition cost of over 80 million pounds, excluding VAT. Further research is required on the longer term impact of drotrecogin alfa (activated) on both mortality and morbidity in UK patients with severe sepsis, on the clinical and cost-effectiveness of drotrecogin alfa (activated) in children (under 18 years) with severe sepsis, and on the effect of the timing of dosage and duration of treatment on outcomes in severe sepsis.

An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis.

“…73 The remaining 15 studies evaluated the cost-effectiveness of other health-care interventions for the treatment of severe sepsis and septic shock. [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89] Five published abstracts were also identified; however, only limited information on the methods employed was reported and so these studies were excluded from the final literature review. A flow chart of studies included in the final costeffectiveness review is shown in Figure 35.…”

“…87 Eleven of the 15 studies reported results in terms of the incremental cost per QALY gained. 74,75,77,[80][81][82][83][84][85][86]88,89 The perspective assumed by each of the studies is also reported in Table 17. The majority of studies considered the perspective of the providing institution (hospital) or of the health-care sector more generally.…”

“…Only two studies 74,82,83 used epidemiological evidence from non-RCT sources to reflect the specific setting of the cost-effectiveness analysis.…”

“…87 Two of the 12 rhAPC studies were from the UK. 80,82,83 The remainder were from the USA (n = 3), [75][76][77] Canada (n = 2), 74,86 France (n = 2), 84,85 Germany (n = 1), 78 Spain (n = 1) 79 and Sweden (n = 1). 81 Both EGDT analyses were from the USA 88,89 and the one albumin study was from France.…”

“…[74][75][76][77][78][79][80][81][82][83][84][85][86] Two studies evaluated the cost-effectiveness of early goaldirected therapy (EGDT) 88,89 and one study evaluated the cost-effectiveness of systemic albumin infusion compared with standard medical care. 87 Two of the 12 rhAPC studies were from the UK.…”