Department of Anaesthesiology and Intensive Care, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden.
Thromb Res. 2010 Jun;125(6):494-500. doi: 10.1016/j.thromres.2009.09.008. Epub 2009 Oct 24.
We have shown that low protein C levels predict poor survival up to five years in a general intensive care unit patient material and hypothesize that treatment with protein C is beneficial. The objectives were to calculate costs of protein C treatment, at best-case scenario, per statistical life saved.
Ninety-two patients with deranged global haemostatic tests admitted to the mixed surgical medical intensive care unit, Malmö University Hospital. We hypothesized that increasing protein C levels in patients with low levels would enhance survival to the same rate as a cohort with higher protein C. Number of statistical lives saved were estimated using survival analysis. Costs per life saved at 30days were calculated.
Total costs per life saved in 2007 prices (upper limit of 95% CI) were calculated at euro 50,200 (recombinant activated protein C, drotrecogin alfa (activated), Xigris) and euro 46,000 (zymogen protein C, Ceprotin), which may be compared to the value of a statistical life (euro 937,000).
Our theoretical model of converting a low protein C group to a higher protein C group by treating with activated protein C or the protein zymogen showed no major difference between the treatments in terms of costs, and that costs are lower than the value of a statistical life. Although our study has several caveats the results support the PROWESS study, in that patients with a very severe disease, having low protein C levels, may benefit from protein C treatment in a cost effective way.
我们已经表明，在普通重症监护病房患者的物质中，低蛋白 C 水平预测五年内的生存状况不佳，并假设蛋白 C 治疗是有益的。目的是计算蛋白 C 治疗的成本，在最佳情况下，每挽救一个统计学生命的成本。
92 名凝血功能异常的患者被收入混合外科内科重症监护病房，马尔默大学医院。我们假设增加低蛋白 C 水平患者的蛋白 C 水平会提高生存率，达到与高蛋白 C 水平患者相同的水平。使用生存分析估计挽救的统计学生命数量。计算 30 天内每挽救一个生命的成本。
2007 年价格（95%CI 上限）下每挽救一个生命的总成本计算为 50200 欧元（重组活化蛋白 C，drotrecogin alfa（活化），Xigris）和 46000 欧元（酶原蛋白 C，Ceprotin），可与一个统计学生命的价值（937000 欧元）相比较。
我们通过使用活化蛋白 C 或蛋白酶原将低蛋白 C 组转化为高蛋白 C 组的理论模型显示，在成本方面，两种治疗方法之间没有明显差异，并且成本低于统计学生命的价值。尽管我们的研究有几个局限性，但结果支持 PROWESS 研究，即患有非常严重疾病、蛋白 C 水平较低的患者可能以具有成本效益的方式从蛋白 C 治疗中受益。
