ArticleCritical care (London, England)2007
Cost-effectiveness of activated protein C in real-life clinical practice.
Article in Critical care (London, England), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Health Economic Evaluations in Intensive Care: An Updated Systematic Review.Critical care explorations · 2025Pooled it
- Propensity scores in intensive care and anaesthesiology literature: a systematic review.Intensive care medicine · 2010Pooled it
- Cost-effectiveness of data driven personalised antibiotic dosing in critically ill patients with sepsis or septic shock.Journal of clinical monitoring and computing · 2025Trial
- Cost-Effectiveness in Critical Care: A Systematic Review of Empirical Evaluations.Healthcare (Basel, Switzerland) · 2025Review
- Health economic evaluations of sepsis interventions in critically ill adult patients: a systematic review.Journal of intensive care · 2020Article
- The efficacy of activated protein C for the treatment of sepsis: incorporating observational evidence with a Bayesian approach.BMJ open · 2015Article
- Is Drotrecogin alfa (activated) for adults with severe sepsis, cost-effective in routine clinical practice?Critical care (London, England) · 2011Article
- The international PROGRESS registry of patients with severe sepsis: drotrecogin alfa (activated) use and patient outcomes.Critical care (London, England) · 2009Article
- Year in review 2007: Critical Care--intensive care unit management.Critical care (London, England) · 2008Review
- Drotrecogin alfa (activated): real-life use and outcomes for the UK.Critical care (London, England) · 2008Article
- Activated protein C: cost-effective or costly?Critical care (London, England) · 2007Article
Corrections and comments
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Authors and funding
13 authors at 9 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecombinant human activated protein C (rhAPC) has been reported to be cost-effective in severely ill septic patients in studies using data from a pivotal randomized trial. We evaluated the cost-effectiveness of rhAPC in patients with severe sepsis and multiple organ failure in real-life intensive care practice.
methodsWe conducted a prospective observational study involving adult patients recruited before and after licensure of rhAPC in France. Inclusion criteria were applied according to the label approved in Europe. The expected recruitment bias was controlled by building a sample of patients matched for propensity score. Complete hospitalization costs were quantified using a regression equation involving intensive care units variables. rhAPC acquisition costs were added, assuming that all costs associated with rhAPC were already included in the equation. Cost comparisons were conducted using the nonparametric bootstrap method. Cost-effectiveness quadrants and acceptability curves were used to assess uncertainty of the cost-effectiveness ratio.
resultsIn the initial cohort (n = 1096), post-license patients were younger, had less co-morbid conditions and had failure of more organs than did pre-license patients (for all: P < 0.0001). In the matched sample (n = 840) the mean age was 62.4 +/- 14.9 years, Simplified Acute Physiology Score II was 56.7 +/- 18.5, and the number of organ failures was 3.20 +/- 0.83. When rhAPC was used, 28-day mortality tended to be reduced (34.1% post-license versus 37.4% pre-license, P = 0.34), bleeding events were more frequent (21.7% versus 13.6%, P = 0.002) and hospital costs were higher (47,870 euros versus 36,717 euros, P < 0.05). The incremental cost-effectiveness ratios gained were as follows: 20,278 euros per life-year gained and 33,797 euros per quality-adjusted life-year gained. There was a 74.5% probability that rhAPC would be cost-effective if there were willingness to pay 50,000 euros per life-year gained. The probability was 64.3% if there were willingness to pay 50,000 euros per quality-adjusted life-year gained.
conclusionThis study, conducted in matched patient populations, demonstrated that in real-life clinical practice the probability that rhAPC will be cost-effective if one is willing to pay 50,000 euros per life-year gained is 74.5%.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.