Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of- hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial

RESUSCITATION

卷:167

Article

Stokes, Elizabeth A.^1,2  Lazaroo, Michelle J.³  Clout, Madeleine³  Brett, Stephen J.⁴  Black, Sarah⁵  Kirby, Kim^5,6  Nolan, Jerry P.^7,8  Reeves, Barnaby C.³  Robinson, Maria⁵  Rogers, Chris A.³  Scott, Lauren J.^3,9  Smartt, Helena³  South, Adrian⁵  Taylor, Jodi^3,7  Thomas, Matthew¹⁰  Voss, Sarah⁶  Benger, Jonathan R.⁶  Wordsworth, Sarah^1,2 

[1] Univ Oxford, Nuffield Dept Populat Hlth, Hlth Econ Res Ctr, Old Rd Campus, Oxford OX3 7LF, England

[2] Oxford NIHR Biomed Res Ctr, Oxford, England

[3] Univ Bristol, Bristol Med Sch, Bristol Trials Ctr, Clin Trials & Evaluat Unit CTEU, Bristol, Avon, England

[4] Imperial Coll London, Dept Surg & Canc, London, England

[5] South Western Ambulance Serv NHS Fdn Trust, Exeter, Devon, England

[6] Univ West England, Glenside Campus, Bristol, Avon, England

[7] Univ Bristol, Bristol Med Sch, Bristol, Avon, England

[8] Royal United Hosp, Dept Anaesthesia, Bath, Avon, England

[9] Univ Hosp Bristol & Weston NHS Fdn Trust, Natl Inst Hlth Res Appl Res Collaborat West NIHR, Bristol, Avon, England

[10] Univ Hosp Bristol NHS Fdn Trust, Intens Care Unit, Bristol, Avon, England

关键词: Cost-effectiveness analysis;    Out of hospital cardiac arrest;    Airway management;   

DOI  :  10.1016/j.resuscitation.2021.06.002

来源: Elsevier

【 摘 要 】

Aim: Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial costeffectiveness analysis. Methods: A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes. Results: 9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months postOHCA were 3570 pound and 3413 pound in the i-gel and TI groups respectively (mean difference 157 pound, 95% CI -270 pound to 583) pound. Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results. Conclusion: The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA.

【 授权许可】

Free