The costs and cost-effectiveness of an integrated sepsis treatment protocol.
Crit Care Med
; 36(4): 1168-74, 2008 Apr.
Article
en En
| MEDLINE
| ID: mdl-18379243
ABSTRACT
CONTEXT Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. OBJECTIVE:
To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care.DESIGN:
Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort.SETTING:
Beth Israel Deaconess Medical Center. PATIENTS Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group.INTERVENTIONS:
An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. MAIN OUTCOMEMEASURES:
In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained.RESULTS:
Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained.CONCLUSIONS:
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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Análisis Costo-Beneficio
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Sepsis
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Años de Vida Ajustados por Calidad de Vida
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Servicio de Urgencia en Hospital
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Antibacterianos
Tipo de estudio:
Guideline
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Health_economic_evaluation
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Observational_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Crit Care Med
Año:
2008
Tipo del documento:
Article
País de afiliación:
Estados Unidos