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Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest
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Achana, Felix A., Petrou, Stavros, Madan, Jason, Khan, Kamran, Ji, Chen, Hossain, Anower, Lall, Ranjit, Slowther, Anne-Marie, Deakin, Charles D., Quinn, Tom, Nolan, Jerry P., Pocock, Helen, Rees, Nigel, Smyth, Michael A., Gates, Simon, Gardiner, Dale and Perkins, Gavin D. (2020) Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest. Critical Care, 24 (1). 579. doi:10.1186/s13054-020-03271-0
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WRAP-cost-effectiveness-adrenaline-out-of-hospital-cardiac-arrest-Perkins-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1096Kb) | Preview |
Official URL: http://dx.doi.org/10.1186/s13054-020-03271-0
Abstract
Background:
The ‘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.
Methods:
We 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.
Results:
The 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.
Conclusions:
Adrenaline 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 registration:
ISRCTN73485024. Registered on 13 March 2014.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment -- Cost effectiveness, Adrenaline -- Cost-effectiveness, Cardiac arrest -- Treatment, Adrenaline -- Receptors | ||||||
| Journal or Publication Title: | Critical Care | ||||||
| Publisher: | BioMed Central Ltd. | ||||||
| ISSN: | 1466-609X | ||||||
| Official Date: | 27 September 2020 | ||||||
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| Volume: | 24 | ||||||
| Number: | 1 | ||||||
| Article Number: | 579 | ||||||
| DOI: | 10.1186/s13054-020-03271-0 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
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