Cost-effectiveness of an emergency department-based early sepsis resuscitation protocol

Alan E. Jones, Jennifer L. Troyer, Jeffrey A. Kline

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

Objectives: Guidelines recommend that sepsis be treated with an early resuscitation protocol such as early goal-directed therapy. Our objective was to assess the cost-effectiveness of implementing early goal-directed therapy as a routine protocol. Design: Prospective before and after study. Setting: Large urban hospital emergency department with >110,000 visits/yr. Patients: The target population was patients with consensus criteria for septic shock. We excluded those with age <18 yrs, no aggressive care desired, or need for immediate surgery. Interventions: Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before; and 2) 2 yrs after implementing early goal-directed therapy as standard of care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were 1-yr mortality, discounted life expectancy, and quality-adjusted life-years. Using costs and quality-adjusted life-years, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a quality-adjusted life-year. RESULTS:: Two hundred eighty-five subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with early goal-directed therapy was associated with an increased hospital cost of $7,028 and an increase in both discounted sepsis-adjusted life expectancy and quality-adjusted life years of 1.5 and 1.3 yrs, respectively. Early goal-directed therapy use was associated with a cost of $5,397 per quality-adjusted life-years gained and the net monetary benefit analysis indicates a 98% probability (p = .038) that early goal-directed therapy is cost-effective at a willingness to pay of $50,000 per quality-adjusted life-years. Conclusion: Implementation of early goal-directed therapy in the emergency department care of patients with severe sepsis is cost-effective.

Original languageEnglish (US)
Pages (from-to)1306-1312
Number of pages7
JournalCritical care medicine
Volume39
Issue number6
DOIs
StatePublished - Jun 2011

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Keywords

  • EGDT
  • cost-effectiveness
  • emergency medicine
  • resuscitation
  • sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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