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Previous Volume 347:993-1000 September 26, 2002 Number 13 Next

	Full Text PDF PDA Full Text Supplementary Material Perspective by Wenzel, R. P. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Recombinant human activated protein C was shown in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study to reduce mortality among patients with severe sepsis. A post hoc reanalysis by the Food and Drug Administration (FDA) of data from this study suggested that the reduction in mortality was restricted to patients with Acute Physiology and Chronic Health Evaluation (APACHE II) scores of 25 or more.

Methods We estimated the cost effectiveness of activated protein C as compared with conventional care for patients with severe sepsis. We performed an economic analysis involving all patients, as well as analyses of subgroups defined according to age and severity of illness. The probabilities of transition between clinical states and the estimates of resource use were derived from a population-based cohort of patients with severe sepsis. We used data on the effectiveness of activated protein C from the PROWESS study and analyses by the FDA.

Results The cost per life-year gained by treating all patients with activated protein C was $27,936. It was more cost effective to treat patients with an APACHE II score of 25 or more ($24,484 per life-year gained) than those with a lower APACHE II score ($35,632 per life-year gained). The cost effectiveness of treating patients with an APACHE II score of 24 or less increased to $575,054 per life-year gained when the FDA's estimates of effectiveness were considered. For patients with an APACHE II score of 25 or more, the cost per life-year gained increased with age ($16,309 for patients less than 40 years of age; $28,100 for those 80 years of age or older).

Conclusions Activated protein C is relatively cost effective when targeted to patients with severe sepsis, greater severity of illness (an APACHE II score of 25 or more), and a reasonable life expectancy if they survive the episode of sepsis. Further research is needed to determine the cost effectiveness of activated protein C for patients with sepsis and less severe illness.

Source Information

From the Department of Medicine (B.J.M., C.J.D.), the Department of Community Health Sciences (B.J.M., C.J.D., C.D.), and the Department of Economics (H.L., C.D.), University of Calgary, Calgary; the Institute of Health Economics, Edmonton (B.J.M., C.D.); the Alberta Centre for Health Services Utilization Research, Edmonton (D.J.); and the Division of Critical Care Medicine, University of Alberta, Edmonton (D.J.) — all in Alberta, Canada.

Address reprint requests to Dr. Manns at the Foothills Medical Center, 1403 29th St. NW, Calgary, AB T2N 2T9, Canada, or at braden.manns{at}calgaryhealthregion.ca.

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