Economic evaluation of new therapies in critical illness

Abstract

The recent Food and Drug Administration approval of drotrecogin alfa (activated) and the potential of several other new therapies may represent the beginning of a breakthrough in the management of critical illness in the intensive care unit. However, their use in clinical practice will likely be dependent on a rigorous appraisal not only of their effects, but also of their costs. Novel therapies can no longer be judged simply by their effectiveness in treating illness, but must also be evaluated on an institutional and societal level on the basis of their cost. These considerations have important implications for the practicing intensivist, who will need to better understand the conduct and design of economic evaluations, including their strengths and weaknesses. In this article, we review the rationale behind economic evaluations of new therapies and the alternative economic approaches available. We then discuss in more detail the elements contained in a cost-effectiveness analysis, the preferred approach to pharmacoeconomic evaluation today.

Pharmacoeconomics of therapy for Guillain–Barré syndrome: plasma exchange and intravenous immunoglobulin

“…Thus, in treating patients with GBS, clinical and economic considerations should be considered when choosing a treatment option. 23 Pharmacoeconomic models can be used to evaluate, predict, and compare the costs and outcomes of different treatments in clinical practice. These models are especially useful in evaluating new treatments in relation to older, more established therapies.…”

Colloid solutions: a clinical update

“…Albumin is also expensive compared to nonprotein colloids, although the exact magnitude of the costs of intravenous fluids in relationship to the total costs of intensive care is difficult to assess [91]. An appropriate indication for albumin might be the replacement of ascites fluid during drainage in patients with cirrhosis and spontaneous bacterial peritonitis [7,92].…”

Economic stress and misaligned incentives in critical care medicine in the United States

“…Cost-effectiveness of new technology and new therapies in critical care has been reviewed recently (25,26). There is an obvious conflict between the demand for innovation in medicine promoted by patients, those providing the care, those manufacturing the technology or therapeutic modality, along with the hospitals that hope to attract patients by demonstrating technological superiority, and those who will need to pay for the innovation.…”