The cost-effectiveness of adjunctive corticosteroids for patients with septic shock

Kelly J Thompson, Colman B Taylor, Balasubramanian Venkatesh, Jeremy Cohen, Naomi E Hammond, Stephen Jan, Qiang Li, John Myburgh, Dorrilyn Rajbhandari, Manoj Saxena, Ashwani Kumar, Simon R Finfer, The ADRENAL Management Committee and Investigators and the ANZICS Clinical Trials Group, Kelly J Thompson, Colman B Taylor, Balasubramanian Venkatesh, Jeremy Cohen, Naomi E Hammond, Stephen Jan, Qiang Li, John Myburgh, Dorrilyn Rajbhandari, Manoj Saxena, Ashwani Kumar, Simon R Finfer, The ADRENAL Management Committee and Investigators and the ANZICS Clinical Trials Group

Abstract

Objective: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock.

Design: Data linkage-based cost-effectiveness analysis.

Setting: New South Wales and Queensland intensive care units.

Participants and intervention: Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial.

Main outcome measures: Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping.

Results: Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications.

Conclusions: Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Consort diagram for the ADRENAL study cost-effectiveness analysis ADRENAL = Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NSW = New South Wales. Qld = Queensland. HR-QoL = health-related quality of life.
Figure 2
Figure 2
Cost-effectiveness plane for hydrocortisone compared with placebo* HC = hydrocortisone. * Mean incremental cost-effectiveness ratio: A$1 254 078 per quality-adjusted life-year gained.

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Source: PubMed

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