Abstract:
BACKGROUND:While drotrecogin alfa (activated) was shown to decrease absolute 28-day mortality by 6.1% in patients with severe sepsis in the Recombinant Human Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study, no mortality benefit was observed in the subset of patients with only one organ system failure. Consequently, some institutions restrict drotrecogin alfa (activated) use to patients with severe sepsis with >/=2 organ system failures. OBJECTIVE:To measure the cost effectiveness of drotrecogin alfa (activated) for treatment of severe sepsis in relation to the number of organ system failures and determine the economic impact of restricting drotrecogin alfa (activated) use based on the number of organ system failures. PERSPECTIVE:Policy perspective specific to our 340-bed, level I trauma centre. METHODS:A Monte Carlo simulation analysis was conducted to evaluate a hypothetical cohort of 10 000 patients with severe sepsis in four scenarios restricting treatment with drotrecogin alfa (activated) to patients with >/=1, >/=2, >/=3 or >/=4 organ system failures. The primary outcomes of 28-day all-cause mortality and serious bleeding were obtained from the PROWESS study. Costs (year 2002 values) were obtained from institutional financial records and literature estimates. The incremental cost per life saved at 28 days with drotrecogin alfa (activated) plus best standard care versus best standard care alone (placebo) was calculated. The incidence of severe sepsis and number of drotrecogin alfa (activated) candidates were estimated through chart review, and projected annual institutional expenditures were derived according to these data. RESULTS:With increasing number of organ system failures, the proportion of lives saved with drotrecogin alfa (activated) increased, and consequently the ICER decreased. Restriction of drotrecogin alfa (activated) to patients with >/=4 organ system failures was the most cost-effective scenario (0.11 lives saved; 56727 US dollars per life saved). For the nine patients that would be treated annually by our institution under this policy, one life would be saved at a total additional cost of 56160 US dollars per year. Use of the drug in patients with >/=1 or >/=2 organ system failures would save the greatest number of lives per year (4-5); however, restricting drotrecogin alfa (activated) to patients with >/=2 organ system failures would be the cheaper alternative (total additional cost 356022 US dollars vs 462204 US dollars . CONCLUSION:While restriction of drotrecogin alfa (activated) use to patients with sepsis with >/=4 organ system failures is the most cost-effective alternative, restriction to those with >/=2 organ system failures is the preferred alternative for our institution according to the number of lives saved and available financial resources.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Betancourt M,McKinnon PS,Massanari RM,Kanji S,Bach D,Devlin JWdoi
10.1007/BF03262331subject
Has Abstractpub_date
2003-01-01 00:00:00pages
1331-40issue
18eissn
1170-7690issn
1179-2027pii
21184journal_volume
21pub_type
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journal_title:PharmacoEconomics
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journal_title:PharmacoEconomics
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journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:PharmacoEconomics
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journal_title:PharmacoEconomics
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abstract::Darunavir boosted by low-dose ritonavir (DRV/r), at a daily dose of 600/100 mg twice a day (bid), has been shown to be superior to alternative highly active antiretroviral therapy (HAART) regimens for the management of treatment-experienced, HIV-infected adults in the phase IIb POWER trials and the phase III TITAN tri...
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:PharmacoEconomics
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更新日期:2014-03-01 00:00:00
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abstract::Rufinamide (Inovelon®), a triazole derivative, is an oral antiepileptic drug approved in the EU as adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients aged ≥4 years. The efficacy of oral rufinamide as adjunctive therapy in patients with LGS uncontrolled on one to t...
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