Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest

Critical Care

Simon Gates¹  Anower Hossain²  Tom Quinn³  Dale Gardiner⁴  Charles D. Deakin⁵  Kamran Khan⁶  Chen Ji⁶  Ranjit Lall⁶  Anne-Marie Slowther⁶  Jason Madan⁶  Gavin D. Perkins⁶  Jerry P. Nolan⁷  Felix Achana⁸  Stavros Petrou⁸  Helen Pocock⁹  Michael Smyth^1,10  Nigel Rees^1,11 

[1] Cancer Clinical Trials Unit, University of Birmingham, Birmingham, UK;Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh;Kingston University and St. George’s, University of London, London, UK;National Clinical Lead for Organ Donation, NHS Blood and Transplant, Bristol, UK;Southampton Respiratory Biomedical Research Unit, National Institute for Health Research, Southampton, UK;Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK;Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK;Critical Care Unit, Royal United Hospital, Bath, UK;Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK;South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK;Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK;West Midlands Ambulance NHS Foundation Trust, Dudley, UK;Welsh Ambulance Services NHS Trust, Swansea, UK;

关键词: Cost-effectiveness of adrenaline;    Cardiac arrest;    Organ donation;    Economics;   

DOI  :  10.1186/s13054-020-03271-0

来源: Springer

【 摘 要 】

BackgroundThe ‘Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration In Cardiac Arrest’ (PARAMEDIC2) trial showed that adrenaline improves overall survival, but not neurological outcomes. We sought to determine the within-trial and lifetime health and social care costs and benefits associated with adrenaline, including secondary benefits from organ donation.MethodsWe estimated the costs, benefits (quality-adjusted life years (QALYs)) and incremental cost-effectiveness ratios (ICERs) associated with adrenaline during the 6-month trial follow-up. Model-based analyses explored how results altered when the time horizon was extended beyond 6 months and the scope extended to include recipients of donated organs.ResultsThe within-trial (6 months) and lifetime horizon economic evaluations focussed on the trial population produced ICERs of £1,693,003 (€1,946,953) and £81,070 (€93,231) per QALY gained in 2017 prices, respectively, reflecting significantly higher mean costs and only marginally higher mean QALYs in the adrenaline group. The probability that adrenaline is cost-effective was less than 1% across a range of cost-effectiveness thresholds. Combined direct economic effects over the lifetimes of survivors and indirect economic effects in organ recipients produced an ICER of £16,086 (€18,499) per QALY gained for adrenaline with the probability that adrenaline is cost-effective increasing to 90% at a £30,000 (€34,500) per QALY cost-effectiveness threshold.ConclusionsAdrenaline was not cost-effective when only directly related costs and consequences are considered. However, incorporating the indirect economic effects associated with transplanted organs substantially alters cost-effectiveness, suggesting decision-makers should consider the complexity of direct and indirect economic impacts of adrenaline.Trial registrationISRCTN73485024. Registered on 13 March 2014.

【 授权许可】

CC BY