Treatment of the critically ill patient with protein C: Is it worth the cost?

Abstract

Introduction: We have shown that low protein C levels predict poor survival up to five years in a general intensive care unit patient material and hypothesize that treatment with protein C is beneficial. The objectives were to calculate costs of protein C treatment, at best-case scenario, per statistical life saved.Materials and methods: Ninety-two patients with deranged global haemostatic tests admitted to the mixed surgical medical intensive care unit, Malmo University Hospital. We hypothesized that increasing protein C levels in patients with low levels would enhance survival to the same rate as a cohort with higher protein C. Number of statistical lives saved were estimated using survival analysis. Costs per life saved at 30 days were calculated.Results: Total costs per life saved in 2007 prices (upper limit of 95% CI) were calculated at (sic) 50,200 (recombinant activated protein C, drotrecogin alfa (activated), Xigris (R)) and (sic) 46,000 (zymogen protein C, Ceprotin), which may be compared to the value of a statistical life ((sic) 937,000).Conclusions: Our theoretical model of converting a low protein C group to a higher protein C group by treating with activated protein C or the protein zymogen showed no major difference between the treatments in terms of costs, and that costs are lower than the value of a statistical life. Although our study has several caveats the results support the PROWESS study, in that patients with a very severe disease, having low protein C levels, may benefit from protein C treatment in a cost effective way. (C) 2009 Elsevier Ltd. All rights reserved.

Keywords

Critical care; Health care costs; Intensive care units; Medical economics; Protein C; Survival analysis

Published in

Thrombosis Research
2010, volume: 125, number: 6, pages: 494-500
Publisher: PERGAMON-ELSEVIER SCIENCE LTD

SLU Authors

• Höjgård, Sören

  • Department of Economics, Swedish University of Agricultural Sciences
    

UKÄ Subject classification

Health Care Service and Management, Health Policy and Services and Health Economy

Publication identifier

• DOI: https://doi.org/10.1016/j.thromres.2009.09.008

Permanent link to this page (URI)

https://res.slu.se/id/publ/61247