Drotrecogin alfa (activated) (DrotAA) is indicated for patients with severe sepsis (SS) at high risk of death. ICD-9-CM code 995.92 for SS became available in October 2002. We sought to characterize the likelihood of having SS and determine whether patients most likely to have SS experience different outcomes depending on timing of DrotAA treatment.
We conducted a retrospective analysis of 2002-2003 discharge data from >400 hospitals in the Premier Perspective(TM) Comparative Database (PCD). The PCD is a large U.S. clinical and economic database developed for quality and utilization benchmarking. We modeled patients’ likelihood of having SS, based on having code 995.92. Our model included medication use, organ dysfunctions, patient demographics and comorbidities, disease state indicators, DRGs, and medical service use. We also stratified patients receiving DrotAA by timing of initiation (Same-day, Next-day, or Later) relative to the first date of evident SS. Then we compared outcomes and resource use between the timing-based subgroups.
Among patients receiving DrotAA who had the top 5% of propensity/likelihood scores, 1,265, 1,034, and 1,101 were Same-day, Next-day, and Later patients, respectively. Among these, Same-day and Next-day DrotAA recipients experienced similar hospital survival rates (53.5% and 52.9%), and higher rates than Later patients (41.8%; both p<.001). Average costs were lower for Same-day versus Next-day patients ($44,251 vs. $52,139; p=.0001), and both were lower than for Later patients ($87,227; both p<.0001). Average LOS was also shorter for Same-day versus Next-day patients (16 days vs. 19 days; p=.0002), and both of these were shorter than for Later patients (30 days; both p<.0001).
Patients with the highest likelihood of having SS who receive DrotAA earlier experience improved survival, costs, and LOS. However, most patients with the highest likelihood of having SS never receive DrotAA.
This may be the first study to examine variation in timing of DrotAA treatment among patients most likely to have SS, as determined by propensity scoring. For treated patients, earlier initiation of treatment for SS is associated with improved outcomes.
Frank Ernst, Employee Eli Lilly and Company