Angiotensin II (ANGII) Reduces Intensive Care Unit (ICU) Length of Stay Providing Cost Savings in the Treatment of Refractory Distributive Shock (DS)

OBJECTIVES: DS results in substantial morbidity and mortality, and its management requires lengthy ICU treatment. Hospitalizations and ICU stays are prolonged, and outcomes are worse, when DS is refractory to standard of care (SoC) vasopressors (catecholamines/vasopressin). ANGII, a novel vasopressor for refractory DS with a complementary mode of action to SoC, results in rapid and sustained blood pressure improvements. We estimate the potential cost-savings and budget impact of ANGII for refractory DS.

METHODS: The ATHOS-3 trial (NCT02338843) compared ANGII+SoC with placebo+SoC for refractory DS. Our model estimates per-patient costs/ budget impact of DS management with ANGII+SoC vs placebo+SoC, based on results for patients with ≥2 vasopressors in ATHOS-3 (229/321 [71%]). Inputs included market-specific drug and hospital costs, and time in ICU, with assumptions for the ANGII-eligible population and ANGII market share.

RESULTS: In the international ATHOS-3 trial, ANGII reduced ICU length of stay (LoS) compared with placebo+SoC (15 vs 17 days). In one of the markets analyzed, Italy, hospital costs contribute 93.3% of total DS management costs with SoC. The reduction in ICU LoS with ANGII results in an estimated reduction in per-patient hospital costs of 2,316 EUR (5.3%). Despite a modest increase in vasopressor drug costs with ANGII, the reduction in ICU LoS and hospital costs drive overall per-patient cost savings of 1,511 EUR (3.2%). This results in potential savings following ANGII introduction for the estimated Italian eligible population (791 patients annually) of 1.3% in year 1 (assuming 40% market share), increasing to 2.0% in year 2 (60% market share) and 2.3% in year 3 (70% market share).

CONCLUSIONS: ANGII is an efficacious vasopressor for refractory DS which reduces ICU LoS and can provide cost savings, as well as reducing pressures on ICU resources. Further analysis will demonstrate the potential cost savings with ANGII in other healthcare systems.