The cost-effectiveness ratio of a managed protocol for severe sepsis

Assunção, Murillo Santucci César de; Teich, Vanessa; Shiramizo, Sandra Christina Pereira Lima; Araújo, Denizart Vianna; Carrera, Renato Melli; Neto, Ary Serpa; Silva, Eliezer

doi:10.1016/j.jcrc.2014.03.008

Cited by 20 publications

(18 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For evaluations of interventions currently used in clinical practice, eight (31%) studies reported incremental cost per life saved (LS) with ICERs ranging from dominant for EGDT [35,39] [40] and a procalcitonin-guided treatment algorithm [29,31] to dominated for PCR testing [46] (see Table 2 and Additional file 3). Only seven (27%) evaluations (of interventions in current clinical use) reported subgroup results for different illness severities with highly variable results (see Additional file 3: Table A3-3).…”

Section: Evaluation Resultsmentioning

confidence: 99%

“…Five evaluations examined antibiotic interventions [22][23][24][25][26], two examined fluid therapies [27,28], eight examined EGDT or other (primarily emergency department [ED]-based) resuscitation protocols [35][36][37][38][39][40][41][42]71], three examined procalcitonin algorithms [29][30][31], two examined immunoglobulin therapies [32][33][34], four examined methods of pathogen identification [43][44][45][46], one examined point of care lactate testing [47], and one examined immediate ICU admission [48]. The remaining 20 evaluations examined interventions no longer used in clinical practice-13 examined drotrecogin alfa (activated) (51-64), and seven examined monoclonal antibodies [64][65][66][67][68][69][70].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All evaluations were performed in patients with suspected or confirmed sepsis, with no evaluations using the updated definitions of sepsis published in 2016 [72]. The majority of evaluations were set in North America (17/46, 37%) and Europe (23/46, 50%), with only 4 (9%) from low and middle income countries or regions [22,39,40,48] (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The reporting quality varied widely, with scores ranging from 13% (3/23) [65] to 95% (21/22) [42,50]. Twelve (26%) of the studies were found to be of excellent [22][23][24][25][26] Fluid therapies 2 (4%) [27,28] Procalcitonin algorithms 3 (7%) [29][30][31] Immmunoglobulin therapies 2 (4%) [32][33][34] EGDT or other sepsis protocol 8 (17%) [35][36][37][38][39][40][41][42][43] Pathogen identification 4 (9%) [44][45][46][47] Other 2 (4%) [48,49] Interventions no longer in clinical practice reporting quality, 18 (39%) of very good quality, 11 (24%) of good quality, and 5 (11%) of poor quality. The quality of evaluations published in the past 15 years was higher (average 75%) than evaluations published prior to 2005 (average 58%), with the quality of evaluations varying by intervention-88% of EGDT and resuscitation protocol evaluations were of very good or excellent quality compared to 60% of evaluations of antibiotic therapies and 25% of evaluations of pathogen identification (Additional file 4).…”

Section: Reporting Qualitymentioning

confidence: 99%

See 3 more Smart Citations

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

et al. 2020

View full text Add to dashboard Cite

Background: Sepsis is a global health priority. Interventions to reduce the burden of sepsis need to be both effective and cost-effective. We performed a systematic review of the literature on health economic evaluations of sepsis treatments in critically ill adult patients and summarised the evidence for cost-effectiveness. Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library using thesaurus (e.g. MeSH) and free-text terms related to sepsis and economic evaluations. We included all articles that reported, in any language, an economic evaluation of an intervention for the management of sepsis in critically ill adult patients. Data extracted included study details, intervention details, economic evaluation methodology, and outcomes. Included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.Results: We identified 50 records representing 46 economic evaluations for a variety of interventions including antibiotics (n = 5), fluid therapy (n = 2), early goal-directed therapy and other resuscitation protocols (n = 8), immunoglobulins (n = 2), and interventions no longer in clinical use such as monoclonal antibodies (n = 7) and drotrecogin alfa (n = 13). Twelve (26%) evaluations were of excellent reporting quality. Incremental costeffectiveness ratios (ICERs) ranged from dominant (lower costs and higher effectiveness) for early goal-directed therapy, albumin, and a multifaceted sepsis education program to dominated (higher costs and lower effectiveness) for polymerase chain reaction assays (LightCycler SeptiFast testing MGRADE®, SepsiTest™, and IRIDICA BAC BSI assay). ICERs varied widely across evaluations, particularly in subgroup analyses. Conclusions: There is wide variation in the cost-effectiveness of sepsis interventions. There remain important gaps in the literature, with no economic evaluations identified for several interventions routinely used in sepsis. Given the high economic and social burden of sepsis, high-quality economic evaluations are needed to increase our understanding of the cost-effectiveness of these interventions in routine clinical practice and to inform decision makers.Trial registration: PROSPERO CRD42018095980

show abstract

Section: Evaluation Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Reporting Qualitymentioning

confidence: 99%

See 2 more Smart Citations

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Unlike the negative results from recently published RCTs, most observational studies demonstrated that SSC bundle adherence was associated with a reduced mortality rate (9,(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74), but without significantly increasing medical cost (75). Over a 7.5-year period running from 2005 till 2012, Levy et al found that compliance to the SSC bundle resulted in a 25% relative mortality risk reduction (76).…”

Section: Compliance With Surviving Sepsis Campaign (Ssc) Bundlementioning

confidence: 99%

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

et al. 2017

View full text Add to dashboard Cite

Severe sepsis and septic shock are major causes of morbidity and mortality in patients entering the emergency department (ED) or intensive care unit (ICU). Despite substantial efforts to improve patient outcome, treatment of sepsis remains challenging to clinicians. In this context, early goal directed therapy (EGDT) represents an important concept emphasizing both early recognition of sepsis and prompt initiation of a structured treatment algorithm. As part of the AME evidence series on sepsis, we conducted a systematic review of all randomized controlled EGDT trials. Focus was laid on the setting (emergency department versus ICU) where EGDT was carried out. Early recognition of sepsis, through clinical or automated systems for early alert, together with well-timed initiation of the recommended therapy bundles may improve patients' outcome. However, the original "EGDT" protocol by Rivers and coworkers has been largely modified in subsequent trials. Currently, many investigators opt for an "expanded" EGDT (as suggested by the Surviving Sepsis Campaign). Evidence is also presented on the effectiveness of automated systems for early sepsis alert. Early recognition of sepsis and well-timed initiation of the SSC bundle may improve patient outcome.

show abstract

Current Challenges in the Management of Sepsis in ICUs in Resource-Poor Settings and Suggestions for the Future

Schultz

Dünser

Dondorp

et al. 2019

Sepsis Management in Resource-Limited Settings

View full text Add to dashboard Cite

The cost-effectiveness ratio of a managed protocol for severe sepsis

Cited by 20 publications

References 22 publications

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review

Early management of sepsis with emphasis on early goal directed therapy: AME evidence series 002

Current Challenges in the Management of Sepsis in ICUs in Resource-Poor Settings and Suggestions for the Future

Contact Info

Product

Resources

About