English, Article edition: Drotrecogin Alfa (Activated): A Pharmacoeconomic Review of its Use in Severe Sepsis James E. Frampton; Rachel H. Foster

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Physical Description
  • article
Language
  • English

Edition details

Title
  • Drotrecogin Alfa (Activated): A Pharmacoeconomic Review of its Use in Severe Sepsis
Author
  • James E. Frampton
  • Rachel H. Foster
Physical Description
  • article
Notes
  • Drotrecogin alfa (activated) [Xigris(R)] {DAA}, the recombinant form of human activated protein C, is approved as an adjunctive therapy for patients with severe sepsis (sepsis associated with >=​1 organ system failure [OSF]). In the international, randomised, double-blind, placebo-controlled PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) study, the absolute reduction in 28-day all-cause mortality with intravenous DAA 24 microg/​kg/​h for 96 hours plus conventional care versus conventional care alone was 6.1%. Although lacking statistical power, a prospectively planned subgroup analysis of this study suggested that the absolute reduction in mortality increased in patients with a baseline APACHE (Acute Physiology and Chronic Health Evaluation) II score of >=​25 or >=​2 OSFs, with no clear treatment effect in patients with an APACHE II score of <=​24 or 1 OSF. Three fully published cost-effectiveness/​cost-utility models of DAA plus conventional care relative to conventional care alone adopted a national healthcare payer's and/​or societal perspective in North America. The base-case (baseline) discounted incremental cost per life-year gained (LYG) with DAA for all patients with severe sepsis was $US15 Among several fully or partly published cost-effectiveness/​cost-utility models that adopted a national healthcare payer's perspective in continental Western European countries, the base-case (baseline) undiscounted incremental cost per LYG was broadly similar and more favourable for patients with >=​2 OSFs ( In conclusion, DAA is a major advance in the treatment of severe sepsis, based on the significant mortality reduction observed in the PROWESS study. From a hospital/​hospital pharmacy perspective, the drug is associated with a high acquisition cost and a small increase in other short-term costs. From a societal or national healthcare payer's perspective, however, its administration to patients who meet the PROWESS study inclusion criteria, especially individuals with more severe disease (e.g APACHE II score of >=​25 and/​or >=​2 OSFs), has a lifetime cost-effectiveness profile that compares well to that of many widely accepted therapies.
  • Adis-Drug-Evaluations, Anticoagulants, Antithrombotics, Cost-analysis, Drotrecogin-alfa
  • RePEc:wkh:phecon:v:22:y:2004:i:7:p:445-476
Language
  • English
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