Abstract
<h3>Objective.</h3> —To evaluate the fiscal impact and the cost-effectiveness of monoclonal antibodies against gram-negative endotoxin (MAbGNE) in the treatment of presumed gram-negative sepsis. <h3>Design.</h3> —A decision analysis model was developed from (1) data from two phase III trials that studied the E5 or HA-1A MAbGNE, and (2) financial data from 1405 septic patients who required intensive care at a large tertiary hospital. <h3>Setting.</h3> —Intensive care unit (ICU) patients with presumed gram-negative sepsis. <h3>Patients.</h3> —The E5 trial evaluated 468 patients, and the HA-1A study enrolled 543 patients with presumed gram-negative sepsis. <h3>Interventions.</h3> —The addition of MAbGNE to standard regimens or standard regimens alone. <h3>Main Outcome Measures.</h3> —Total expected charges and the expected probability of survival were determined for each option. Cost-effectiveness and marginal cost-effectiveness ratios were also derived. Multiple sensitivity and Monte Carlo analyses were performed to test the underlying assumptions. <h3>Results.</h3> —MAbGNE therapy always resulted in higher expected charges; however, these differences were less than its acquisition cost by $870. The cost-effectiveness ratio for MAbGNE, for $2000 and $4000 acquisition costs, was $71 674 and $74 900 per probability of survival, respectively. Sensitivity analysis showed that cost-effectiveness was most affected by diagnostic accuracy, patient selection, and acquisition cost. Monte Carlo analysis showed that MAbGNE was more costly for 71% of simulations, yet the most efficacious option for 79% of simulations. <h3>Conclusions.</h3> —From the perspective of acute care institutions, MAbGNE is expensive and cannot be justified on a cost-saving basis. However, it may be cost-effective throughout a reasonable range of assumptions. (<i>JAMA</i>. 1993;269:249-254)
Keywords
MedicineGramSepsisMonoclonal antibodyGram-negative bacteriaIntensive care medicineGram-negative bacterial infectionsAntibodyImmunologyMicrobiologyAntibioticsBacteriaEscherichia coli
Affiliated Institutions
Related Publications
Treatment of Gram-Negative Bacteremia and Septic Shock with HA-1A Human Monoclonal Antibody against Endotoxin
HA-1A is safe and effective for the treatment of patients with sepsis and gram-negative bacteremia.
A New Simplified Acute Physiology Score (SAPS II) Based on a European/North American Multicenter Study
<h3>Objective.</h3> —To develop and validate a new Simplified Acute Physiology Score, the SAPS II, from a large sample of surgical and medical patients, and to provide a method ...
The Epidemiology of Sepsis in the United States from 1979 through 2000
The incidence of sepsis and the number of sepsis-related deaths are increasing, although the overall mortality rate among patients with sepsis is declining. There are also dispa...
The Logistic Organ Dysfunction System
<h3>Objective.</h3> —To develop an objective method for assessing organ dysfunction among intensive care unit (ICU) patients on the first day of the ICU stay. <h3>Design and Set...
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021
INTRODUCTION Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (1). Sepsis and septic shock are major healthcare problems, impacti...
Publication Info
- Year
- 1993
- Type
- article
- Volume
- 269
- Issue
- 2
- Pages
- 249-249
- Citations
- 102
- Access
- Closed
External Links
Social Impact
Altmetric
PlumX Metrics
Social media, news, blog, policy document mentions
Citation Metrics
102
OpenAlex
Cite This
Donald B. Chalfin
(1993).
Cost-effectiveness of Monoclonal Antibodies to Gram-negative Endotoxin in the Treatment of Gram-negative Sepsis in ICU Patients.
JAMA
, 269
(2)
, 249-249.
https://doi.org/10.1001/jama.1993.03500020083037
Identifiers
- DOI
- 10.1001/jama.1993.03500020083037