Original

Intensive Care Medicine

, Volume 37, Issue 3, pp 444-452

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

  • David SuarezAffiliated withUnidad de Epidemiología y Evaluación, Instituto Universitario Fundación Parc Tauli, Universidad Autónoma de Barcelona Email author 
  • , Ricard FerrerAffiliated withServicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Instituto Universitario Parc Tauli, Universidad Autónoma de Barcelona
  • , Antonio ArtigasAffiliated withServicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Instituto Universitario Parc Tauli, Universidad Autónoma de Barcelona
  • , Izaskun AzkarateAffiliated withServicio de Medicina Intensiva, Hospital de Donostia
  • , José Garnacho-MonteroAffiliated withServicio de Medicina Intensiva, Hospital Universitario Virgen del Rocio
  • , Gemma GomàAffiliated withServicio de Medicina Intensiva, Hospital de Sabadell, CIBER Enfermedades Respiratorias, Instituto Universitario Parc Tauli, Universidad Autónoma de Barcelona
  • , Mitchell M. LevyAffiliated withMedical ICU, Rhode Island Hospital, Brown University School of Medicine
  • , Juan Carlos RuizAffiliated withServei de Medicina Intensiva, Grup de Recerca en Shock, Disfunció Orgànica i Ressuscitació (SODIR), Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’ Hebron (VHIR), Universitat Autònoma de Barcelona
  • , For the Edusepsis Study Group

Abstract

Context

Severe sepsis is associated with high mortality and increased costs. The ‘Surviving Sepsis Campaign’ (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown.

Objective

To determine the cost-effectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis.

Design

Observational prospective before-and-after study.

Setting

59 medical-surgical intensive care units located throughout Spain.

Patients

A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the post-educational program cohort (SSC protocol care of severe sepsis).

Interventions

The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions.

Main outcome measures

Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER).

Results

Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114–3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02–1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG.

Conclusion

The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.

Keywords

Severe sepsis Cost-effectiveness analysis Outcome Protocol