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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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Official URL: http://dx.doi.org/10.1186/s13054-020-03271-0

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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
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
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
Dates:
DateEvent
27 September 2020Published
7 August 2020Accepted
Date of first compliant deposit: 3 November 2020
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
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
12/127/126[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
Contributors:
ContributionNameContributor ID
Research GroupPARAMEDIC2 Collaborators, UNSPECIFIED

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