Cost-effectiveness of polymyxin B hemoperfusion for septic shock: an observational study using a Japanese nationwide administrative database

BACKGROUND: Polymyxin B hemoperfusion (PMX) removes endotoxin from septic shock patients. Although the treatment has been clinically used for more than 20 years, its cost-effectiveness has not been evaluated in detail. METHODS: This study used the Japanese diagnosis procedure combination (DPC) administrative database from April 2018 to March 2021. We selected adult patients with a primary diagnosis of sepsis and the SOFA score at the sepsis diagnosis was between 7 and 12. The patients were divided into the PMX group that received PMX treatment and the control group that did not receive PMX. After adjusting the patient background by propensity score matching, we calculated the incremental cost-effectiveness ratio (ICER) by determining the difference in quality-adjusted life-year (QALY) and medical cost between the PMX and the control groups. RESULTS: Nineteen thousand two hundred eighty-three patients were included in the study. Among them, 1492 patients received PMX treatment, and 17,791 did not. As a result of 1:3 propensity score matching, 965 patients in the PMX group and 2895 patients in the control group were selected and analyzed. Twenty-eight-day mortality and hospital mortality were significantly lower in the PMX group. The average medical cost per patient of the PMX group was 31,418 ± 21,144 Euro and that of the control group was 24,483 ± 21,762 Euro, with a difference of 6935 Euro. Life expectancy, life year-gained (LYG), and the QALY were 1.70, 0.86, and 0.60 years longer in the PMX group, respectively. The ICER was calculated to be 11,592 Euro/year, which was lower than the reported willingness-to-pay threshold of 38,462 Euro/year. CONCLUSION: Polymyxin B hemoperfusion was shown to be an acceptable treatment in terms of the medical economy.