TY - JOUR
T1 - Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest
AU - PARAMEDIC2 Collaborators
AU - Achana, Felix
AU - Petrou, Stavros
AU - Madan, Jason
AU - Khan, Kamran
AU - Ji, Chen
AU - Hossain, Anower
AU - Lall, Ranjit
AU - Slowther, Anne-Marie
AU - Deakin, Charles D
AU - Quinn, Tom
AU - Nolan, Jerry P
AU - Pocock, Helen
AU - Rees, Nigel
AU - Smyth, Michael
AU - Gates, Simon
AU - Gardiner, Dale
AU - Perkins, Gavin D
PY - 2020/9/27
Y1 - 2020/9/27
N2 - 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.
AB - 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.
KW - Cardiac arrest
KW - Cost-effectiveness of adrenaline
KW - Economics
KW - Organ donation
UR - http://www.scopus.com/inward/record.url?scp=85091810311&partnerID=8YFLogxK
U2 - 10.1186/s13054-020-03271-0
DO - 10.1186/s13054-020-03271-0
M3 - Article
C2 - 32981529
SN - 1466-609X
VL - 24
SP - 579
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 579
ER -