Cost-effectiveness of immunoglobulin M-enriched immunoglobulin (Pentaglobin) in the treatment of severe sepsis and septic shock.

摘要

PURPOSE: To measure the cost-effectiveness of a specific polyclonal intravenous immune globulin preparation (Pentaglobin) in adult patients treated for severe sepsis and septic shock. MATERIALS AND METHODS: Effectiveness data from a meta-analysis of 9 randomized trials (N = 435) were used to populate a decision model to estimate the cost-effectiveness of Pentaglobin and its comparator standard therapy from the hospital perspective in Germany. Primary outcome: all-cause morality; secondary outcome: intensive care unit (ICU) length of stay. Benefit was expressed as lives saved (LS). Published cost data were applied to assess differences in ICU treatment costs. Cost-effectiveness was calculated as incremental cost per LS. RESULTS: Pentaglobin reduced the risk of mortality (P < .001) but had no effect on ICU length of stay. A baseline risk of mortality of 0.4434 (risk ratio = 0.5652; absolute risk reduction = 0.1928; number-needed-to-treat = 5.19) increased ICU treatment costs with Pentaglobin by 2037 (22711 vs 24747) with a cost per LS of 10565. Sensitivity analyses on baseline mortality risk (95% confidence interval 0.3293-0.5162) and risk ratio (95% confidence interval 0.4306-0.7420) yielded a cost per LS range of 5715 to 28443 with a 56.3% probability of cost-effectiveness of 12000 or less. CONCLUSIONS: Pentaglobin is a promising adjuvant therapy both clinically and economically for treatment of adults with severe sepsis and septic shock.