Cost-effectiveness of monoclonal antibodies to gram-negative endotoxin in the treatment of gram-negative sepsis in ICU patients

Donald B. Chalfin, M. E Blair Holbein, Alan M. Fein, Graziano C. Carlon

Research output: Contribution to journalArticle

Abstract

Objective. - 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. Design. - 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. Setting. - Intensive care unit (ICU) patients with presumed gram-negative sepsis. Patients. - The E5 trial evaluated 468 patients, and the HA-1A study enrolled 543 patients with presumed gram-negative sepsis. Interventions. - The addition of MAbGNE to standard regimens or standard regimens alone. Main Outcome Measures. - 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. Results. - 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. Conclusions. - From the perspective of acute care institutions, MAbGNE is expensive and cannot be justified on a cost-saving basis. However, it may be costeffective throughout a reasonable range of assumptions.

Original languageEnglish (US)
Pages (from-to)249-254
Number of pages6
JournalJournal of the American Medical Association
Volume269
Issue number2
StatePublished - Jan 13 1993

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Endotoxins
Cost-Benefit Analysis
Intensive Care Units
Sepsis
Monoclonal Antibodies
Costs and Cost Analysis
Therapeutics
Survival
Decision Support Techniques
Critical Care
Tertiary Care Centers
Patient Selection
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Cost-effectiveness of monoclonal antibodies to gram-negative endotoxin in the treatment of gram-negative sepsis in ICU patients. / Chalfin, Donald B.; Holbein, M. E Blair; Fein, Alan M.; Carlon, Graziano C.

In: Journal of the American Medical Association, Vol. 269, No. 2, 13.01.1993, p. 249-254.

Research output: Contribution to journalArticle

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