OBJECTIVES: Sepsis is a burdensome condition worldwide in terms of morbidity, mortality and financial cost to health systems. The recent Surviving Sepsis Campaign (SSC) has published new guidelines for septic patients. However, deviation from guidelines is frequent in intensive care units. A retrospective cohort study using a least absolute shrinkage and selection operator penalized machine learning model, carried out by Kalimouttou and colleagues, has identified and analyzed 22 recommendations (77,2% compliance with guidelines) extracted from 2 US databases. Among the 22 items, 6 are associated with a reduction in 28-day all-cause mortality; one is vasopressin (OR: 0.74, 95%CI 0.65;0.86). The aim of this analysis is to analyze the cost-effectiveness of adding vasopressin to standard-of-care (SOC) versus SOC to assess outcomes (costs, mortality, SOFE or APACHEII, ICU stay, requirement of RRT etc.)

METHODS: A decision tree structure plus Markov model is used to describe the time-span of the sepsis related hospitalization over 28 days. A Markov structure is then used to represent long-term outcomes including survival, adverse effects (ESRD and atrial fibrillation) and quality-adjusted life-years (QALYs). Resource-utilization and direct costs (2023€) were derived from published sources from the German payer’s perspective. A willingness-to-pay threshold set at 25,000€/QALY gained was incorporated. One-way and probabilistic sensitivity analysis were performed.

RESULTS: Adding vasopressin to the SOC to manage sepsis/septic shock is associated with direct costs of 72,135€ (SD, 3,218€). SOC is associated with total costs of 84,104€ [SD, 4,414€]. Adding vasopressin yields cost savings of about 11,969€ per patient and a QALY gain of 0.53 or 6.3 months in perfect health. Patients in the vasopressin-group exhibit a shorter ICU-stay (-1 day) and a lower RRT requirement (-11.5%). Vasopressin plus SOC is the dominant strategy.

CONCLUSIONS: In patients with sepsis/septic shock, the use of vasopressin plus SOC is highly cost-effective and associated with savings for the German healthcare system.