Pid7: Observational Evaluation of Health State Utilities Among a Cohort of Sepsis Patients

Abstract

OBJECTIVE: Among sepsis survivors, during recovery and thereafter, it is not established if patients resume or improve their quality of life. The study objective was to assess change in health status among sepsis survivors over a 6‐month period. METHODS: This was a prospective, multicenter, cohort study involving 701 patients with severe sepsis of presumed infectious origin from 53 hospitals. Patients' health status was assessed at day 30, 60, 90 and180 using EuroQoL‐5D and a visual analog scale. Instruments were completed by the patient while in hospital and follow‐up assessments were performed by telephone interview. RESULTS: For this interim analysis, 93 patients had completed health state information for day 30, 60, 90, and 180. Mean (SD) age was 60 + 17 years and 48% were female. The number of patients remaining in the hospital decreased from 56% at day 30 to 7%, thereafter. The average utility score/VAS score at each time point was: 0.53/0.61 (day 30), 0.62/0.68 (day 60), 0.68/0.71 (day 90), 0.69 (p < 0.0001)/0.72 (day 180). Based on patients' subjective assessment of their health status during the last 12 months, 60% had improved or maintained their health. The improvement in utility scores was influenced primarily by changes in mobility, self‐care, and usual activities. Pain and anxiety appeared to have a minimal influence on overall improvement in health status. At day 30, 28% of the patients reported no problems in walking, compared to 58% at day 180. Likewise, 48% and 26% of patients reported no problems with self‐care and performing usual activities at day 30, respectively, and 67% (self‐care) and 47% (usual activities) at day 180. CONCLUSION: Sepsis survivors experienced a continual improvement towards population‐based normal levels in their health utility scores over a 6‐month period. Improvements in physical activity, self‐care and usual activities were predominantly associated with improved health utility.

An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis.

“…96,[109][110][111] The flow chart of the search results and inclusion/exclusion of the studies is provided in Figure 40. A summary of these studies is reported in Table 26.…”

“…In all four studies, 96,[109][110][111] utilities were derived using the EQ-5D instrument. The EQ-5D is a standardised instrument for use as a measure of health outcome and is applicable to a wide range of health conditions and treatments.…”

“…Two studies 96,109 reported patients' utility values for multiple time points, informing how the quality of life of sepsis survivors might alter over time. The abstract by Drabinski et al 96 (previously identified by Green et al 82 ) assessed changes in health status at days 30, 60, 90 and 180, suggesting that quality of life appears to improve within the first few months after a sepsis episode and then appears to plateau between 3 months and 6 months after the episode.…”

“…Our updated review identified three additional studies [109][110][111] to those previously reported 96 by Green et al 82 These additional studies provided evidence that (1) the quality of life of sepsis patients appears to be lower than that of the age-and sex-adjusted general population (even before the clinical illness), 109 (2) the utility values of sepsis survivors appear to improve over time 96,109 (with much of this improvement incurring during the first months after sepsis episode) 96 and (3) surviving patients have a lower utility value than the general population even 1.5 years after the initial episode. 109 Although these studies provide useful information to assist in drawing general conclusions about the potential long-term impact of severe sepsis on health utility, several limitations were identified in relating the findings from these studies to appropriate parameter values and assumptions to be applied in our own decision model.…”

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

“…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].…”