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

Research output: Contribution to journalArticlepeer-review

Authors

  • PARAMEDIC2 Collaborators

Colleges, School and Institutes

External organisations

  • THE UNIVERSITY OF WARWICK
  • University of Dhaka
  • National Institute for Health Research
  • Kingston University and St George's, University of London, London, UK.
  • Welsh Ambulance Services NHS Trust
  • National Clinical Lead for Organ Donation

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.

Details

Original languageEnglish
Pages (from-to)579
JournalCritical care (London, England)
Volume24
Issue number1
Publication statusPublished - 27 Sep 2020