Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest
Felix Achana, Stavros Petrou, Jason Madan, Kamran Khan, Chen Ji, Md. 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, Stavros Petrou, Jason Madan, Kamran Khan, Chen Ji, Md. 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, Matthew W Cooke, Sarah E Lamb, Andrew Carson, Ian Jacobs, Ed England, John J. Black, Nicola Brock, C. M. Godfrey, Sarah Taylor, Michelle Edwards Thomson, Isabel Rodriguez-Bachiller, Claire King, Marie Stevens, Johanna Lazarus, Helen Werts, Joshua L. Golding, Rachel Fothergill, Fionna Moore, Alex Boda, Richard Whitfield, L. Galligan, Rob Lovett, Jennifer Bradley, Lyndsay O’Shea, Mark Docherty, Imogen Gunsen, Gill M Price, Andy Rosser, Garry Parcell, Mindy Jhamat, Josh Miller, Jenny Sears Brown, Alice Pretty, Madison Larden, Emma Harris, Jenny Lumley-Holmes, Rhiannon Boldy, Prudence Horwood, Kyee Han, Karl Charlton, Sonia Byers, Gary M. Shaw, Matt Limmer, Craig Wynne, Michelle C. Jackson, Emma Bell, Oliver Gupta, Rima Gupta, Charlotte Scomparin, Susie Hennings, Jessica Horton, James W. Buck, Sarah Rumble, Hayley Johnson, Eva Kritzer, Chockalingham Muthiah, Adrian Willis, Claire Daffern, Louise Clarkson, Felix Achana, Nicola Cashin, Emma Skilton, Malvenia Richmond, Martin Underwood, Natalie Strickland, Sarah Duggan
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.