COST-EFFECTIVENESS OF DROTRECOGIN ALFA (ACTIVATED) IN THE TREATMENT OF SEVERE SEPSIS WITH MULTIPLE ORGAN FAILURE Short title: cost-effectiveness of drotrecogin alfa

Objectives: To estimate the expected cost and clinical benefits associated with the use of drotrecogin alfa (activated) [Xigris; Eli Lilly and Company; Indianapolis, IN] in the French hospital setting. Methods: The PROWESS study results (1,271 patients with multiple organ failure) were adjusted to 9,948 hospital stays from a database of Parisian area intensive care units (ICUs) – the CubRea database. The analysis features a decision tree with a probabilistic sensitivity analysis. Results: The cost per life-year gained (LYG) of drotrecogin treatment for severe sepsis with multiple organ failure (European indication) was estimated to be $11,812. At the hospital level, the drug is expected to induce an additional cost of $7,545 per treated patient. The incremental cost-effectiveness ratio ranges from $7,873 per LYG for patients receiving three organ supports during ICU stay to $17,704 per LYG for patients receiving less than two organ supports. Conclusions: Drotrecogin alfa (activated) is cost-effective in the treatment of severe sepsis with multiple organ failure when added to best standard care. The cost-effectiveness of the drug increases with baseline disease severity, but it remains cost-effective for all patients when used in compliance with the European approved indication.