Cost effectiveness of drotrecogin alfa (activated) for the treatment of severe sepsis in the United Kingdom*

Abstract

SummaryDrotrecogin alfa (activated) is licensed in Europe for the treatment of severe sepsis in patients with multiple organ failure. We constructed a model to assess the cost effectiveness of drotrecogin alfa (activated) from the perspective of the UK National Health Service when used in adult intensive care units. Patient outcomes from a 28-day international clinical trial (PROWESS) and a subsequent follow-up study (EVBI) were supplemented with UK data. Cost effectiveness was assessed as incremental cost per life year and per quality adjusted life year saved compared to placebo alongside best usual care. Applying the 28-day mortality outcomes of the PROWESS study, the model produced a cost per life year saved of £4608 and cost per quality adjusted life year saved of £6679. Equivalent results using actual hospital outcomes were £7625 per life year and £11 051 per quality adjusted life year. Drotrecogin alfa (activated) appears cost effective in treating severe sepsis in UK intensive care units.

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.…”

“…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.…”

Treatment of the critically ill patient with protein C: Is it worth the cost?

“…Economic evaluations in several countries including the United Kingdom, France, Germany, Sweden, the United States, and Canada [30][31][32][33][34][35][36][37] show that APC is cost effective, on a short-term basis, in severe sepsis. Further, when APC is administered, according to the PROWESS criteria, to individuals with more severe disease (APACHE II score ≥25), it has a lifetime cost-effectiveness profile that compares well to that of many widely accepted therapies [33,35].…”