An Evaluation of the Cost Effectiveness of Drotrecogin Alfa (Activated) Relative to the Number of Organ System Failures

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 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; $US56 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.