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. 2020 Sep 27;24(1):579.
doi: 10.1186/s13054-020-03271-0.

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

Felix Achana  1   2 , Stavros Petrou  1   2 , Jason Madan  1 , Kamran Khan  1 , Chen Ji  1 , Anower Hossain  3 , Ranjit Lall  1 , Anne-Marie Slowther  1 , Charles D Deakin  4 , Tom Quinn  5 , Jerry P Nolan  1   6 , Helen Pocock  1   7 , Nigel Rees  8 , Michael Smyth  1   9 , Simon Gates  10 , Dale Gardiner  11 , Gavin D Perkins  12 ; PARAMEDIC2 Collaborators
Collaborators, Affiliations

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

Felix Achana et al. Crit Care. .

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.

Keywords: Cardiac arrest; Cost-effectiveness of adrenaline; Economics; Organ donation.

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Conflict of interest statement

MAS reports funding from the National Institute for Health Research. MAS has volunteer roles with the International Liaison Committee on Resuscitation, European and Resuscitation Council UK.

TQ reports grant funding paid to his institution by the National Institute for Health Research and British Heart Foundation. TQ has volunteer roles with the European Society of Cardiology.

GDP reports grant funding paid to his institution from the National Institute for Health Research, Resuscitation Council UK and British Heart Foundation related to this work. GDP has volunteer roles with the International Liaison Committee on Resuscitation, European and Resuscitation Council UK and Intensive Care Foundation. GDP is supported as a NIHR Senior Investigator and serves as an Editor for Resuscitation.

SP is supported by a Senior Investigator award from the UK National Institute of Health Research.

NR reports grants from National Institute for Health Research and Health and Care Research Wales during the conduct of the study.

Figures

Fig. 1
Fig. 1
Model diagrams. Plot a: Model to extrapolate cost-effectiveness beyond PARAMEDIC2 trial follow-up. OHCA represents health state for out-of-hospital cardiac arrest patients. Good represents survival with good neurological function. Poor represents survival with poor neurological function. Plot b: Organ donor model adapted from Fisher et al. [26]
Fig. 2
Fig. 2
Flow chart of data sources used to inform resource use and costs. S2HD indicates survivors to hospital discharge, HES/PEDW indicates Hospital Episode Statistics/Patient Episode Database for Wales
Fig. 3
Fig. 3
The three graphs on the left-hand side represent the cost-effectiveness plane for the within-trial, lifetime and the combined cardiac arrest and organ donor analyses. The three graphs on the right-hand side represent cost-effectiveness acceptability curves and give the probability that adrenaline is cost-effective compared with placebo at a specified cost-effectiveness threshold. Each cost-effectiveness plane is divided into four quadrants (North-West, North-East, South-West and South-East) by the intersection of the horizontal and vertical axis. South-East quadrant implies adrenaline is less costly and more effective than placebo, North-West quadrant implies adrenaline is less effective and more costly, the North-East quadrant implies adrenaline is more effective but also more costly and the South-West quadrant implies adrenaline is less effective but also less costly
See this image and copyright information in PMC

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