Cost-effectiveness of the Surviving Sepsis Campaign protocol for severe sepsis: a prospective nation-wide study in Spain

Intensive Care Med. 2011 Mar;37(3):444-52. doi: 10.1007/s00134-010-2102-3. Epub 2010 Dec 9.


Context: Severe sepsis is associated with high mortality and increased costs. The 'Surviving Sepsis Campaign' (SSC) protocol was developed as an international initiative to reduce mortality. However, its cost-effectiveness is unknown.

Objective: To determine the cost-effectiveness of the SSC protocol for the treatment of severe sepsis in Spain after the implementation of an educational program compared with the conventional care of severe sepsis.

Design: Observational prospective before-and-after study.

Setting: 59 medical-surgical intensive care units located throughout Spain.

Patients: A total of 854 patients were enrolled in the pre-educational program cohort (usual or standard care of severe sepsis) and 1,465 patients in the post-educational program cohort (SSC protocol care of severe sepsis).

Interventions: The educational program aimed to increase adherence to the SSC protocol. The SSC protocol included pharmacological and medical interventions.

Main outcome measures: Clinical (hospital mortality) and economic (health-care resource and treatment costs) outcomes were recorded. A health-care system perspective was used for costs. The primary outcome was incremental cost-effectiveness ratio (ICER).

Results: Patients in the SSC protocol care cohort had a lower risk of hospital mortality (44.0% vs. 39.7%, P = 0.04). However, mean costs per patient were 1,736 euros higher in the SSC protocol care cohort (95% CI 114-3,358 euros), largely as a result of increased length of stay. Mean life years gained (LYG) were higher in the SSC protocol care cohort: 0.54 years (95% CI 0.02-1.05 years). The adjusted ICER of the SSC protocol was 4,435 euros per LYG. Nearly all (96.5%) the bootstrap replications were below the threshold of 30,000 euros per LYG.

Conclusion: The SSC protocol seems to be a cost-effective option for treating severe sepsis in Spain.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Clinical Protocols*
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Intensive Care Units / economics
  • Male
  • Middle Aged
  • Observation
  • Prospective Studies
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Sepsis / drug therapy
  • Sepsis / economics*
  • Sepsis / mortality*
  • Severity of Illness Index
  • Spain / epidemiology
  • Surgery Department, Hospital
  • Survival Analysis


  • Hypoglycemic Agents
  • Insulin