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Long-term costs and cost-effectiveness of adjunctive corticosteroids for patients with septic shock in New Zealand.
Thompson, Kelly J; Young, Paul J; Venkatesh, Balasubramanian; Cohen, Jeremy; Finfer, Simon R; Grattan, Sarah; Hammond, Naomi E; Jan, Stephen; Li, Qiang; Di Tanna, Gian Luca; McArthur, Colin; Myburgh, John; Rajbhandari, Dorrilyn; Taylor, Colman B.
Afiliação
  • Thompson KJ; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia.
  • Young PJ; Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
  • Venkatesh B; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; The Princess Alexandra Hospital, University of Queensland, Brisbane, Australia; The Wesley Hospital, Brisbane, Australia.
  • Cohen J; The George Institute for Global Health, Sydney, Australia.
  • Finfer SR; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Imperial College, London, UK; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
  • Grattan S; The George Institute for Global Health, Sydney, Australia.
  • Hammond NE; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
  • Jan S; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
  • Li Q; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia.
  • Di Tanna GL; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia.
  • McArthur C; Medical Research Institute of New Zealand, Wellington, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
  • Myburgh J; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; St George Clinical School, University of New South Wales, Sydney, Australia.
  • Rajbhandari D; The George Institute for Global Health, Sydney, Australia.
  • Taylor CB; The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia. Electronic address: ctaylor@georgeinstitute.org.au.
Aust Crit Care ; 35(3): 241-250, 2022 05.
Article em En | MEDLINE | ID: mdl-34325975
ABSTRACT

OBJECTIVE:

The aim of the study was to determine whether adjunctive hydrocortisone reduced healthcare expenditure and was cost-effective compared with placebo in New Zealand patients in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial.

DESIGN:

This is a health economic analysis using data linkage to New Zealand Ministry of Health databases to determine resource use, costs, and cost-effectiveness for a 24-month period.

SETTING:

The study was conducted in New Zealand. PARTICIPANTS AND INTERVENTION Patients with septic shock were randomised to receive a 7-day continuous infusion of 200 mg of hydrocortisone or placebo in the ADRENAL trial. MAIN OUTCOME

MEASURES:

Healthcare expenditure was associated with all hospital admissions, emergency department presentations, outpatient visits, and pharmacy expenditure. Effectiveness outcomes included mortality at 6 months and 24 months and quality of life at 6 months. Cost-effectiveness outcomes were assessed with reference to quality-adjusted life years gained at 6 months and life years gained at 24 months.

RESULTS:

Of 3800 patients in the ADRENAL trial, 419 (11.0%) were eligible, and 405 (96.7% of those eligible) were included. The mean total costs per patient over 24 months were $143,627 ± 100,890 and $143,772 ± 97,117 for the hydrocortisone and placebo groups, respectively (p = 0.99). Intensive care unit costs for the index admission were $50,492 and $62,288 per patient for the hydrocortisone and placebo groups, respectively (p = 0.09). The mean number of quality-adjusted life years gained at 6 months and mean number of life years gained at 24 months was not significantly different by treatment group, and the probability of hydrocortisone being cost-effective was 55% at 24 months.

CONCLUSIONS:

In New Zealand, adjunctive hydrocortisone did not reduce total healthcare expenditure or improve outcomes compared with placebo in patients with septic shock.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque Séptico Tipo de estudo: Clinical_trials / Health_economic_evaluation Limite: Humans País/Região como assunto: Oceania Idioma: En Revista: Aust Crit Care Assunto da revista: ENFERMAGEM / TERAPIA INTENSIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Austrália
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Choque Séptico Tipo de estudo: Clinical_trials / Health_economic_evaluation Limite: Humans País/Região como assunto: Oceania Idioma: En Revista: Aust Crit Care Assunto da revista: ENFERMAGEM / TERAPIA INTENSIVA Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Austrália