• 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, and The ADRENAL Management Committee and Investigators and the ANZICS Clinical Trials Group .
• The George Institute for Global Health, Sydney, NSW, Australia. kthompson@georgeinstitute.org.
• Crit Care Resusc. 2020 Sep 1; 22 (3): 191199191-199.

ObjectiveTo determine whether hydrocortisone is a cost-effective treatment for patients with septic shock.DesignData linkage-based cost-effectiveness analysis.SettingNew South Wales and Queensland intensive care units.Participants And InterventionPatients 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 MeasuresHealth-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.ResultsOf 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.ConclusionsAdjunctive 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.

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