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

Achana, Felix, Petrou, Stavros, Madan, Jason, Khan, Kamran, Jin, Chen, Hossain, Anower, Lall, Ranjit, Slowther, Anne-Marie, Deakin, Charles D., Quinn, Tom, Nolan, Jerry P., Pocock, Helen, Rees, Nigel, Smyth, Michael, Gates, Simon, Gardiner, Dale, Perkins, Gavin D. and PARAMEDIC2 Collaborators (2020) Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest. Critical Care, 24, p. 579. ISSN (print) 1364-8535


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.

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