The costs and cost-effectiveness of an integrated sepsis treatment protocol

Talmor, Daniel; Greenberg, Dan; Howell, Michael D.; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

doi:10.1097/ccm.0b013e318168f649

Cited by 107 publications

(66 citation statements)

References 31 publications

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“…However, the estimated ICER (4,435 euros per LYG) was significantly lower than the commonly accepted threshold of 30,000 euros per LYG used in Spain [31]. Moreover, our results are in agreement with those of a recent study conducted in the US that showed that a protocol similar to the SSC protocol is a cost-effective alternative to the usual care of severe sepsis with an ICER of 11,274 dollars per LYG (8,906 euros per LYG) [17]. Another similar recent study, also conducted in the US, showed even better results as the sepsis protocol both improved mortality and reduced costs [33].…”

Section: Discussionsupporting

confidence: 90%

“…We then adjusted these life expectancies using the estimated reduction rate for sepsis survivors, 0.51, suggested by Quartin et al [14]. This approach was recently used to assess the cost-effectiveness of severe sepsis interventions [15][16][17]. LYGs were discounted at an annual rate of 3%.…”

Section: Life-years Gained and Quality-adjusted Life Yearsmentioning

confidence: 99%

“…This value takes into account the decrease in quality of life after surviving severe sepsis. Again, this estimate was recently used to assess the cost effectiveness of severe sepsis interventions [17]. This utility weight was obtained from a study of 6-month survivors of severe sepsis using the EuroQol-5D questionnaire [18,19].…”

Section: Life-years Gained and Quality-adjusted Life Yearsmentioning

confidence: 99%

“…In the primary analysis, we did not include the costs of staff time in the costs of the educational program, as we considered that the training sessions formed part of ongoing continuing medical education. This approach was adopted in two previous similar studies [17,33]. However, as others might question this approach, we conducted a sensitivity analysis including the cost of the entire educational program (54,270 euros, see Table 1 of the supplementary material) as well as the costs of the time staff spent attending the educational program.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

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Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

et al. 2010

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Context: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown. Objective: To determine the costeffectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis. Design: Observational prospective before-and-after study. Setting: 59 medical-surgical intensive care units located throughout Spain. Patients: A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the posteducational program cohort (SSC protocol care of severe sepsis). Interventions: The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions. Main outcome measures: Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER). Results: Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114-3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02-1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG. Conclusion: The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.

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Section: Discussionsupporting

confidence: 90%

Section: Life-years Gained and Quality-adjusted Life Yearsmentioning

confidence: 99%

Section: Life-years Gained and Quality-adjusted Life Yearsmentioning

confidence: 99%

Section: Sensitivity Analysesmentioning

confidence: 99%

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Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

et al. 2010

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“…By combining quantitative and qualitative data, the most efficient and cost‐effective solution for a clinical problem can be evaluated11, 12, 13. Those outcomes help decision‐makers (NHS funding) to derive evidence‐based decisions on long‐term costs savings and, importantly, individual and societal wellbeing14, 15, 16.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Ebm¹,

Aggarwal

Huddart

et al. 2018

BJS Open

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BackgroundThe recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in‐hospital and societal costs of implementing the ELPQuiC bundle.MethodsThe ELPQuiC study employed a before–after approach using quality improvement methodology. To assess the costs and cost‐effectiveness of the bundle, two models were constructed: a short‐term model to assess in‐hospital costs and a long‐term model (societal decision tree) to evaluate the patient's lifetime costs (in euros).ResultsUsing health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64–40 784·06) per hospital. In‐hospital costs per patient were estimated at €14 817·24 for standard (non‐care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality‐adjusted life‐year saved.ConclusionImplementation of the ELPQuiC bundle is associated with lower mortality and higher in‐hospital costs but reduced societal costs.

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Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality

Chang

Shapiro

2016

JAMA Intern Med

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IMPORTANCE Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. OBJECTIVE To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. MAIN OUTCOMES AND MEASURES The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. RESULTS The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ Ն 0.90 for all comparisons; P < .01 for all). For each condition, hospital-level ICU utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. CONCLUSIONS AND RELEVANCE For medical conditions where ICU care is frequently provided, but may not always be necessary, institutions that utilize ICUs more frequently are more likely to perform invasive procedures and have higher costs but have no improvement in hospital mortality. Hospitals had similar ICU utilization patterns across the 4 medical conditions, suggesting that systematic institutional factors may influence decisions to potentially overutilize ICU care. Interventions that seek to improve the value of critical care services will need to address these factors that lead clinicians to admit patients to higher levels of care when equivalent care can be delivered elsewhere in the hospital.

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The costs and cost-effectiveness of an integrated sepsis treatment protocol

Abstract: In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

Cited by 107 publications

References 31 publications

Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality

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