Cost-effectiveness of an emergency department-based early sepsis resuscitation protocol

Crit Care Med. 2011 Jun;39(6):1306-12. doi: 10.1097/CCM.0b013e31821201be.


Objectives: Guidelines recommend that sepsis be treated with an early resuscitation protocol such as early goal-directed therapy. Our objective was to assess the cost-effectiveness of implementing early goal-directed therapy as a routine protocol.

Design: Prospective before and after study.

Setting: Large urban hospital emergency department with >110,000 visits/yr.

Patients: The target population was patients with consensus criteria for septic shock. We excluded those with age <18 yrs, no aggressive care desired, or need for immediate surgery.

Interventions: Clinical and cost data were prospectively collected on two groups: 1) patients from 1 yr before; and 2) 2 yrs after implementing early goal-directed therapy as standard of care. Before phase patients received nonprotocolized care at attending discretion. The primary outcomes were 1-yr mortality, discounted life expectancy, and quality-adjusted life-years. Using costs and quality-adjusted life-years, we constructed an incremental cost-effectiveness ratio and performed a net monetary benefit analysis, producing the probability that the intervention was cost-effective given different values for the willingness to pay for a quality-adjusted life-year.

Results: Two hundred eighty-five subjects, 79 in the before and 206 in the after phases, were enrolled. Treatment with early goal-directed therapy was associated with an increased hospital cost of $7,028 and an increase in both discounted sepsis-adjusted life expectancy and quality-adjusted life years of 1.5 and 1.3 yrs, respectively. Early goal-directed therapy use was associated with a cost of $5,397 per quality-adjusted life-years gained and the net monetary benefit analysis indicates a 98% probability (p = .038) that early goal-directed therapy is cost-effective at a willingness to pay of $50,000 per quality-adjusted life-years.

Conclusion: Implementation of early goal-directed therapy in the emergency department care of patients with severe sepsis is cost-effective.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Clinical Protocols
  • Cohort Studies
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Quality-Adjusted Life Years
  • Resuscitation / economics*
  • Retrospective Studies
  • Sepsis / diagnosis
  • Sepsis / mortality
  • Sepsis / therapy*
  • Standard of Care / economics*
  • Survival Rate
  • Treatment Outcome