TY - JOUR
T1 - The cost-effectiveness of early goal-directed therapy
T2 - an economic evaluation alongside the ARISE trial
AU - on behalf of the ARISE Investigators
AU - ANZICS Clinical Trials Grp
AU - Higgins, Alisa M.
AU - Peake, Sandra L.
AU - Bellomo, Rinaldo A. O.
AU - Cooper, D. Jamie A. O.
AU - Delaney, Anthony
AU - Howe, Belinda D.
AU - Nichol, Alistair D.
AU - Webb, Steve A.
AU - Williams, Patricia J.
AU - Harris, Anthony H.
PY - 2021/9
Y1 - 2021/9
N2 - Objective: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock.Design: Within-trial cost-effectiveness evaluation.Setting: Nineteen hospitals in Australia and New Zealand.Participants and interventions: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation.Outcome measures: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective.Results: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, -$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%.Conclusions: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective.
AB - Objective: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock.Design: Within-trial cost-effectiveness evaluation.Setting: Nineteen hospitals in Australia and New Zealand.Participants and interventions: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation.Outcome measures: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective.Results: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, -$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%.Conclusions: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective.
KW - SEVERE SEPSIS
KW - SEPTIC SHOCK
KW - CONSENSUS DEFINITIONS
KW - RESUSCITATION
KW - OUTCOMES
KW - IMPLEMENTATION
U2 - 10.51893/2021.3.OA10
DO - 10.51893/2021.3.OA10
M3 - Article
SN - 1441-2772
VL - 23
SP - 329
EP - 336
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 3
ER -