Long-term costs and cost-effectiveness of adjunctive corticosteroids for patients with septic shock in New Zealand |
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| Affiliation: | 1. The George Institute for Global Health, Sydney, Australia;2. University of New South Wales, Sydney, Australia;3. Medical Research Institute of New Zealand, Wellington, New Zealand;4. Intensive Care Unit, Wellington Hospital, Wellington, New Zealand;5. The Princess Alexandra Hospital, University of Queensland, Brisbane, Australia;6. The Wesley Hospital, Brisbane, Australia;7. Imperial College, London, UK;8. Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia;9. St George Clinical School, University of New South Wales, Sydney, Australia;10. Faculty of Medicine and Health, University of Sydney, Sydney, Australia;11. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand;1. Frankston Hospital, Frankston, VIC Australia;2. The Bays Hospital, Mornington, VIC Australia;3. Monash University, Frankston, VIC Australia;4. Werribee Mercy Hospital, Werribee, VIC, Australia;5. Austin Health VIC, Heidelburg, Australia;6. Griffith University, University of Queensland, Qld Australia;7. Flinders University and Flinders Medical Center, SA, Australia;8. Aster CMI Hospital, Bangalore, India;9. Western Health, VIC, Australia;10. National University Hospital, Singapore;11. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;12. University of Sydney, Nepean Clinical School and Nepean Hospital, Kingswood, NSW, Australia;13. Anaesthesia and Intensive Care Unit, Imperial College London, London, UK;14. Anesthesia and Intensive Care Unit, Sundsvall Hospital, Sundsvall, Sweden;15. Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland;p. University of Queensland, Brisbane, Qld, Australia;q. Bond University, Gold Coast, Qld, Australia;r. Calvary Public Hospital, ACT, Canberra, Australia;s. Casey Monash Hospital, Berwick, VIC, Australia;1. Department of Nutrition and Dietetics, Royal Adelaide Hospital, South Australia, Australia;2. Intensive Care Unit, Royal Adelaide Hospital, South Australia, Australia;3. Discipline of Acute Care Medicine, The University of Adelaide, South Australia, Australia;4. Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, South Australia, Australia;5. Allied and Scientific Health Office (ASHO), Department for Health & Wellbeing, Adelaide, South Australia, Australia;1. Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France;2. Ecole Universitaire de Kinésithérapie Centre Val de Loire, Orléans, France;1. Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia;2. 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia;3. Hugo Centre for Population and Housing, University of Adelaide, Napier Building, North Terrace, Adelaide, SA 5000, Australia;4. Intensive Care Unit, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, VIC 3010, Australia;5. The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia, VIC 3050;1. Department of Nephrology, Postgraduate Institute of Medical Institute Education and Research, Chandigarh, India;2. NephroPlus Dialysis Network, Hyderabad, India;3. Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Institute Education and Research, Chandigarh, India;4. George Institute for Global Health, UNSW, New Delhi, India;5. School of Public Health, Imperial College, London, UK;6. Manipal Academy of Higher Education, Manipal, India |
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| Abstract: | ObjectiveThe 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.DesignThis 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.SettingThe study was conducted in New Zealand.Participants and interventionPatients 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 measuresHealthcare 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.ResultsOf 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.ConclusionsIn 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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| Keywords: | Sepsis Septic shock Cost-effectiveness analysis Economic evaluation Corticosteroids Intensive care medicine |
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