Cost-effectiveness of adrenaline for out-of-hospital cardiac arrest
Authors: Achana Felix , Petrou Stavros , Madan Jason , Khan Kamran , Ji 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. ,   for the PARAMEDIC2 Collaborators, Petrou Stavros , Madan Jason , Khan Kamran , Ji 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. , Cooke Matthew , Lamb Sarah , Carson Andrew , Jacobs Ian , England Ed , Black John , Brock Nicola , Godfrey Claire , Taylor Sarah , Thomson Michelle , Rodriguez-Bachiller Isabel , King Claire , Stevens Marie , Lazarus Johanna , Werts Helen , Golding Joshua , Fothergill Rachel , Moore Fionna , Boda Alex , Whitfield Richard , Galligan Laura , Lovett Rob , Bradley Jennifer , O’Shea Lyndsay , Docherty Mark , Gunsen Imogen , Price Gill , Rosser Andy , Parcell Garry , Jhamat Mindy , Miller Josh , Brown Jenny Sears , Pretty Alice , Larden Madison , Harris Emma , Lumley-Holmes Jenny , Boldy Rhiannon , Horwood Prudence , Han Kyee , Charlton Karl , Byers Sonia , Shaw Gary , Limmer Matt , Wynne Craig , Jackson Michelle , Bell Emma , Gupta Oliver , Gupta Rima , Scomparin Charlotte , Hennings Susie , Horton Jessica , Buck James , Rumble Sarah , Johnson Hayley , Kritzer Eva , Muthiah Chockalingham , Willis Adrian , Daffern Claire , Clarkson Louise , Achana Felix , Cashin Nicola , Skilton Emma , Richmond Malvenia , Underwood Martin , Strickland Natalie , Duggan Sarah , Regan Scott , Wood Jill , Nicholl Jon , Bayliss Neil , Snooks Helen , Benger Jonathan , Andrews Robert , Pitcher David , Lee William , Wise Matt , Campbell Marion , Soar Jasmeet , Rowan Kathy , Mason Sue 
Published: September 2020

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.