OBJECTIVES Polymyxin B-immobilized hemoperfusion cartage (PMX) is a medical device for the treatment of severe sepsis by adsorbing and eliminating plasma endotoxin. The objective of this study is to assess the clinical effectiveness and cost-effectiveness of PMX vs. conventional therapy in treating patients with severe sepsis. METHODS For a systematic review, we searched OVID, EMBASE and Cochrane central register of controlled trial (CENTRAL). Inclusion criteria of clinical trials were RCTs on ‘sepsis', ‘severe sepsis' and ‘septic shock' patients. We included those studies that reported at least one of the four specified outcomes: mortality, plasma endotoxin level, days of ICU stay and blood pressure. Relevant outcomes were synthesized using RevMan 5.0. The average medical cost of sepsis was estimated from a national health insurance (NHI) claims database and the PMX related cost was calculated from the fee schedule of NHI. For economic evaluation, we assessed incremental cost effectiveness ratio (ICER) of PMX compared with conventional therapy. The assessment was performed from a purchaser's perspective. RESULTS A total of 11 RCTs were identified with pooled sample size of 802; 477 in PMX and 325 in conventional therapy group. Meta-analysis results showed that PMX therapy had significantly lower mortality risk. The 28-day mortality rate of PMX group and conventional therapy group were 35.4% and 70.4% respectively with risk ratio of 0.51 (95% CI, 0.43-0.59). The medical cost for sepsis turned out 3,536,000 KRW per patient, which is common in PMX and conventional treatment. The additional cost related to PMX treatment was estimated to be KRW5,496,984 KRW per patient. Applying this mortality outcome and cost data, we produced an ICER of KRW15,705,669 per life gained. CONCLUSIONS Compared with conventional therapy alone, PMX therapy with conventional therapy for the treatment of severe sepsis was found clinically superior and cost-effective as well.