Critical Care (Sep 2020)

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

  • Felix Achana,
  • Stavros Petrou,
  • Jason Madan,
  • Kamran Khan,
  • Chen Ji,
  • Anower Hossain,
  • Ranjit Lall,
  • Anne-Marie Slowther,
  • Charles D. Deakin,
  • Tom Quinn,
  • Jerry P. Nolan,
  • Helen Pocock,
  • Nigel Rees,
  • Michael Smyth,
  • Simon Gates,
  • Dale Gardiner,
  • Gavin D. Perkins,
  • for the PARAMEDIC2 Collaborators

DOI
https://doi.org/10.1186/s13054-020-03271-0
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 12

Abstract

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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.

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