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

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Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest. / PARAMEDIC2 Collaborators.

In: Critical care (London, England), Vol. 24, No. 1, 27.09.2020, p. 579.

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PARAMEDIC2 Collaborators. / Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest. In: Critical care (London, England). 2020 ; Vol. 24, No. 1. pp. 579.

Bibtex

@article{eef06fe16e0d46ebaee137b574966356,
title = "Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest",
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.",
author = "{PARAMEDIC2 Collaborators} and Felix Achana and Stavros Petrou and Jason Madan and Kamran Khan and Chen Ji and Anower Hossain and Ranjit Lall and Anne-Marie Slowther and Deakin, {Charles D} and Tom Quinn and Nolan, {Jerry P} and Helen Pocock and Nigel Rees and Michael Smyth and Simon Gates and Dale Gardiner and Perkins, {Gavin D}",
year = "2020",
month = sep,
day = "27",
doi = "10.1186/s13054-020-03271-0",
language = "English",
volume = "24",
pages = "579",
journal = "Critical Care",
issn = "1466-609X",
publisher = "Springer",
number = "1",

}

RIS

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.

U2 - 10.1186/s13054-020-03271-0

DO - 10.1186/s13054-020-03271-0

M3 - Article

C2 - 32981529

VL - 24

SP - 579

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 1

ER -