Abstract
Objective: Sepsis occurs in a heterogeneous population. A prospective nationwide surveillance study found that populations stratified by infection type had significant differences in the incidence of sepsis syndrome, rate of complications and mortality. The objective of this study was to explore whether successful identification of population-specific risk factors for disease-associated morbidity and mortality may allow for more accurate assessment of the cost effectiveness of treatment strategies.
Design: A decision analytic model was developed using outcomes data on incidence and resolution of major complications in sepsis syndrome. Healthcare resource utilisation data were based on length of hospital stay, intensive care unit stay versus hospital ward stay, and cost of treating sepsis-related complications.
Setting: This modelling study, conducted from the perspective of the healthcare institution, used actual outcomes data on 2 infection-specific patient populations.
Patients and participants: The 2 populations studied were patients with nosocomial respiratory tract infection or community-acquired urinary tract infection who subsequently developed sepsis syndrome.
Interventions: Treatment options modelled were standard therapy plus biotechnology therapy versus standard therapy alone in the treatment of gram-negative sepsis complications.
Main outcome measures and results: The incremental cost-effectiveness ratios differed between the 2 study populations, due to differences in the incidence and rate of resolution of major sepsis-associated complications. The use of biotechnology therapy is always more cost effective in the respiratory tract infection population.
Conclusions: Cost-effectiveness results for a therapy may change when the epidemiology of the disease state is known and incorporated into the decision analytic model. An infection-specific approach is important in the treatment of sepsis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Pinner RW, Teutsch SM, Simonsen L, et al. Trends in infectious diseases mortality in the United States. JAMA 1996; 275: 189–93
Ziegler EJ, Fisher Jr CJ, Sprung CL, et al. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. N Engl J Med 1991; 324: 429–36
Greenman RL, Schein RMH, Martin MA, et al. A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 1991; 226: 1097–102
Bone RC, Balk RA, Fein AM, et al. A second large controlled clinical study of E5, a monoclonal antibody to endotoxin: results of a prospective, multicenter, randomized, controlled trial. Crit Care Med 1995; 23: 994–1006
McCloskey RV, Straube RC, Sanders C, et al. Treatment of septic shock with human monoclonal antibody HA-1A. Ann Intern Med 1994; 121: 1–5
Bernard GR. Sepsis trials: intersection of investigation, regulation, funding, and practice. Am J Respir Crit Care Med 1995; 152: 4–10
Schulman KA, Yabroff KR, Glick H. A health services approach for the evaluation of innovative pharmaceutical and biotechnology products. Drug Inf J 1995; 29: 1405–14
Conboy K, Welage LS, Walawander CA, et al. Sepsis syndrome and associated sequelae in patients at high risk for gram-negative sepsis. Pharmacotherapy 1995; 15: 66–77
Chalfin DB, Holbein MEB, Fein AM, et al. Cost-effectiveness of monoclonal antibodies to gram-negative endotoxin in the treatment of gram-negative sepsis in ICU patients. JAMA 1993; 269: 249–54
Schulman KA, Glick HA, Rubin H, et al. Cost-effectiveness of HA-1A monoclonal antibody for gram-negative sepsis. JAMA 1991; 266: 3466–71
Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical decision analysis. Philadelphia (PA): WB Saunders Company, 1980
Brady HR, Brenner BM. Acute renal failure. In: Isselbacher K, Braunwald E, Wilson JD, et al., editors. Harrison’s principles of internal medicine. New York (NY): McGraw-Hill Inc, 1994: 1265–74
Ingram Jr RH. Adult respiratory distress syndrome. In: Isselbacher K, Braunwald E, Wilson JD, et al., editors. Harrison’s principles of internal medicine. New York (NY): McGraw-Hill Inc, 1994: 1240–3
Handin RI. Disorders of coagulation and thrombosis. In: Isselbacher K, Braunwald E, Wilson JD, et al., editors. Harrison’s principles of internal medicine. New York (NY): McGraw-Hill Inc, 1994: 1804–10
Wilkins JC, Dabrows MB. Hematologic emergencies: management of hyperleukocytic syndrome, DIC, and thrombotic thrombocytopenic purpura. Postgrad Med 1993; 93: 93–202
Parno JR, Teres D, Lemeshow S, et al. Hospital charges and long-term survival of ICU versus non-ICU patients. Crit Care Med 1982; 10: 569–74
Jacobs P, Noseworthy TW. National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 1990; 18: 1282–6
Petitti DB. Meta-analysis, decision analysis, and cost-effectiveness analysis. New York (NY): Oxford University Press, 1994
Hollenberg J. SMLTREE: the all-purpose decision-tree builder. Boston (MA): Pratt Medical Group, 1985
Pauker SG, Kassirer JP. Decision analysis. N Engl J Med 1987; 316: 250–8
HCIA Inc, Ernst and Young LLP. The DRG handbook: comparative clinical and financial standards. Baltimore (MD): HCIA Inc, 1995
Chassin MR. Costs and outcomes of medical intensive care. Med Care 1982; 20: 165–79
Dragsted L, Qvist J. Epidemiology of intensive care. Int J Technol Assess Health Care 1992; 8: 395–407
Author information
Authors and Affiliations
Corresponding author
Additional information
* Work conducted while a PharmD candidate at the Department of Pharmacy Practice, State University of New York at Buffalo, Buffalo, New York, USA
Rights and permissions
About this article
Cite this article
Wang, E.C.Y., Grasela, T.H. & Walawander, C.A. Applying Epidemiology-Based Outcomes Research to Clinical Decision-Making. Pharmacoeconomics 15, 385–393 (1999). https://doi.org/10.2165/00019053-199915040-00006
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199915040-00006