• Felix Achana, Stavros Petrou, Jason Madan, Kamran Khan, Chen Ji, Anower Hossain, Ranjit Lall, Anne-Marie Slowther, Charles D Deakin, Tom Quinn, Jerry P Nolan, Helen Pocock, Nigel Rees, Michael Smyth, Simon Gates, Dale Gardiner, Gavin D Perkins, and PARAMEDIC2 Collaborators.
• Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Coventry, UK.
• Crit Care. 2020 Sep 27; 24 (1): 579.

BackgroundThe 'Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration In Cardiac Arrest' (PARAMEDIC2) trial showed that adrenaline improves overall survival, but not neurological outcomes. We sought to determine the within-trial and lifetime health and social care costs and benefits associated with adrenaline, including secondary benefits from organ donation.MethodsWe estimated the costs, benefits (quality-adjusted life years (QALYs)) and incremental cost-effectiveness ratios (ICERs) associated with adrenaline during the 6-month trial follow-up. Model-based analyses explored how results altered when the time horizon was extended beyond 6 months and the scope extended to include recipients of donated organs.ResultsThe within-trial (6 months) and lifetime horizon economic evaluations focussed on the trial population produced ICERs of £1,693,003 (€1,946,953) and £81,070 (€93,231) per QALY gained in 2017 prices, respectively, reflecting significantly higher mean costs and only marginally higher mean QALYs in the adrenaline group. The probability that adrenaline is cost-effective was less than 1% across a range of cost-effectiveness thresholds. Combined direct economic effects over the lifetimes of survivors and indirect economic effects in organ recipients produced an ICER of £16,086 (€18,499) per QALY gained for adrenaline with the probability that adrenaline is cost-effective increasing to 90% at a £30,000 (€34,500) per QALY cost-effectiveness threshold.ConclusionsAdrenaline was not cost-effective when only directly related costs and consequences are considered. However, incorporating the indirect economic effects associated with transplanted organs substantially alters cost-effectiveness, suggesting decision-makers should consider the complexity of direct and indirect economic impacts of adrenaline.Trial RegistrationISRCTN73485024 . Registered on 13 March 2014.

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