Cost-effectiveness of the surviving sepsis campaign protocol for severe sepsis: A prospective nation-wide study in Spain

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. © 2010 Copyright jointly held by Springer and ESICM.