Cost-effectiveness of an emergency department-based early sepsis resuscitation protocol.
Cost-effectiveness of an emergency department-based early sepsis resuscitation protocol.
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DOI：
10.1097/ccm.0b013e31821201be
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发表时间：
2011-06
影响因子：
8.8
通讯作者：
Kline JA
中科院分区：
文献类型：
--
作者：
Jones AE;Troyer JL;Kline JA
指南建议采用早期复苏方案治疗脓毒症，如早期目标导向治疗（EGDT）。我们的目标是评估实施EGDT作为常规方案的成本效益。研究前后的前瞻性研究。大型城市医院艾德，就诊人数> 110，000/年。目标人群为符合感染性休克共识标准的患者。我们排除了年龄<18岁、不需要积极治疗或需要立即手术的患者。前瞻性收集两组患者的临床和成本数据：1）实施EGDT标准治疗前1年和2）实施EGDT标准治疗后2年的患者。在此之前，患者根据主治医生的判断接受非方案治疗。主要结果是一年死亡率、贴现预期寿命和质量调整生命年（Qs）。使用成本和QALY，我们构建了一个增量成本效益比，并进行了净货币效益（NMB）分析，产生的概率，干预是成本效益的不同值的愿意支付的QALY。入组了285例受试者，其中79例在治疗前阶段，206例在治疗后阶段。EGDT治疗增加了7028美元的住院费用，并分别增加了1.5年和1.3年的折扣脓毒症调整后的预期寿命和QDs。EGDT的使用与每QALY获得5397美元的成本相关，NMB分析表明，在愿意支付每QALY 50，000美元的情况下，EGDT具有成本效益的概率为98%（p = 0.038）。在严重脓毒症患者的艾德护理中实施EGDT具有成本效益。
Guidelines recommend that sepsis be treated with an early resuscitation protocol, such as early goal directed therapy (EGDT). Our objective was to assess the cost-effectiveness of implementing EGDT as a routine protocol. Prospective before and after study. Large urban hospital ED with >110,000 visits/year. 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. Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before and 2) 2 yrs after implementing EGDT as standard-of-care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were one year mortality, discounted life expectancy, and quality adjusted life years (QALYs). Using costs and QALYs, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit (NMB) analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a QALY. 285 subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with EGDT was associated with an increased hospital cost of $7028 and an increase in both discounted sepsis-adjusted life expectancy and QALYs of 1.5 and 1.3 yrs, respectively. EGDT use was associated with a cost of $5397 per QALY gained and the NMB analysis indicates a 98% probability (p = .038) that EGDT is cost-effective at a willingness to pay of $50,000 per QALY. Implementation of EGDT in the ED care of severe sepsis patients is cost effective.