Green Colin, Dinnes Jacqueline, Takeda Andrea L, Cuthbertson Brian H
Southampton Health Technology Assessment Centre, University of Southampton, UK.
Int J Technol Assess Health Care. 2006 Winter;22(1):90-100. doi: 10.1017/s0266462306050884.
The aim of this study was to assess the cost-effectiveness of drotrecogin alfa (activated) compared with best supportive care in a UK cohort of adult intensive-care patients with severe sepsis.
A systematic review of evidence on the clinical- and cost-effectiveness of drotrecogin alfa (activated) was undertaken, and a decision-analytic model was developed to estimate the cost-effectiveness of treatment in the United Kingdom. Trial data from the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study have been synthesized with other data, including UK data on severe sepsis, to estimate the costs and consequences of treatment over time.
For patients with severe sepsis and multiple organ dysfunction, the estimates of cost per life year and cost per quality-adjusted life year (QALY) are pounds 4931 and pounds 8228, respectively. For patients with severe sepsis alone, the cost per life-year and cost per QALY are pouhds 5495 and pounds 9161, respectively.
Whereas the therapeutic cost for drotrecogin alfa (activated) appears high (at around pounds 5000 per patient) and the potential impact on the provider budget is considerable, drotrecogin alfa (activated) is clinically effective, represents a cost-effective use of resources, and is a significant advance in the treatment of severe sepsis in patients requiring intensive care.
本研究旨在评估在英国一组患有严重脓毒症的成年重症监护患者中，与最佳支持治疗相比，重组人活化蛋白C（drotrecogin alfa，活化型）的成本效益。
对重组人活化蛋白C（drotrecogin alfa，活化型）的临床和成本效益证据进行了系统评价，并建立了一个决策分析模型来估计在英国进行治疗的成本效益。来自严重脓毒症全球重组人活化蛋白C评估（PROWESS）研究的试验数据已与其他数据（包括英国严重脓毒症数据）进行综合，以估计随时间推移治疗成本和结果。
对于患有严重脓毒症和多器官功能障碍的患者，每生命年成本和每质量调整生命年（QALY）成本的估计分别为4931英镑和8228英镑。对于仅患有严重脓毒症的患者，每生命年成本和每QALY成本分别为5495英镑和9161英镑。
虽然重组人活化蛋白C（drotrecogin alfa，活化型）的治疗成本似乎很高（约每位患者5000英镑），且对医疗服务提供者预算的潜在影响相当大，但重组人活化蛋白C（drotrecogin alfa，活化型）在临床上是有效的，代表了资源的成本效益使用，并且是在需要重症监护的严重脓毒症患者治疗方面的一项重大进展。
