• Elizabeth A Stokes, Michelle J Lazaroo, Madeleine Clout, Stephen J Brett, Sarah Black, Kim Kirby, Jerry P Nolan, Barnaby C Reeves, Maria Robinson, Chris A Rogers, Lauren J Scott, Helena Smartt, Adrian South, Jodi Taylor, Matthew Thomas, Sarah Voss, Jonathan R Benger, and Sarah Wordsworth.
• Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK.
• Resuscitation. 2021 Oct 1; 167: 1-9.

AimOptimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.MethodsA within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a six-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.Results9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to six months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI -0.0059 to 0.0028). Total costs per participant up to six months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI -£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.ConclusionThe small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA.Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

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