Praveen Thokala1, Gordon W Fuller2, Steve Goodacre3, Samuel Keating4, Esther Herbert4, Gavin D Perkins5, Andy Rosser6, Imogen Gunson6, Joshua Miller6, Matthew Ward6, Mike Bradburn4, Tim Harris7, Maggie Marsh8, Kate Ren1, Cindy Cooper4. 1. Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. 2. Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. g.fuller@sheffield.ac.uk. 3. Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. 4. Clinical Trials and Research Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. 5. Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK. 6. West Midlands Ambulance Service, Trust Headquarters, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands, DY5 1LX, UK. 7. School of Medicine and Dentistry, Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK. 8. Sheffield Emergency Care Forum, Clinical Research Office Sheffield, Royal Hallamshire Hospital, D Floor, Glossop Road, Sheffield, S10 2JF, UK.
Abstract
BACKGROUND: Standard prehospital management for Acute respiratory failure (ARF) involves controlled oxygen therapy. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment, however, it is uncertain whether this could improve outcomes and provide value for money. This study aimed to evaluate the cost-effectiveness of prehospital CPAP in ARF. METHODS: A cost-utility economic evaluation was performed using a probabilistic decision tree model synthesising available evidence. The model consisted of a hypothetical cohort of patients in a representative ambulance service with undifferentiated ARF, receiving standard oxygen therapy or prehospital CPAP. Costs and quality adjusted life years (QALYs) were estimated using methods recommended by NICE. RESULTS: In the base case analysis, using CPAP effectiveness estimates form the ACUTE trial, the mean expected costs of standard care and prehospital CPAP were £15,201 and £14,850 respectively and the corresponding mean expected QALYs were 1.190 and 1.128, respectively. The mean ICER estimated as standard oxygen therapy compared to prehospital CPAP was £5685 per QALY which indicated that standard oxygen therapy strategy was likely to be cost-effective at a threshold of £20,000 per QALY (67% probability). The scenario analysis, using effectiveness estimates from an updated meta-analysis, suggested that prehospital CPAP was more effective (mean incremental QALYs of 0.157), but also more expensive (mean incremental costs of £1522), than standard care. The mean ICER, estimated as prehospital CPAP compared to standard care, was £9712 per QALY. At the £20,000 per QALY prehospital CPAP was highly likely to be the most cost-effective strategy (94%). CONCLUSIONS: Cost-effectiveness of prehospital CPAP depends upon the estimate of effectiveness. When based on a small pragmatic feasibility trial, standard oxygen therapy is cost-effective. When based on meta-analysis of heterogeneous trials, CPAP is cost-effective. Value of information analyses support commissioning of a large pragmatic effectiveness trial, providing feasibility and plausibility conditions are met.
BACKGROUND: Standard prehospital management for Acute respiratory failure (ARF) involves controlled oxygen therapy. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment, however, it is uncertain whether this could improve outcomes and provide value for money. This study aimed to evaluate the cost-effectiveness of prehospital CPAP in ARF. METHODS: A cost-utility economic evaluation was performed using a probabilistic decision tree model synthesising available evidence. The model consisted of a hypothetical cohort of patients in a representative ambulance service with undifferentiated ARF, receiving standard oxygen therapy or prehospital CPAP. Costs and quality adjusted life years (QALYs) were estimated using methods recommended by NICE. RESULTS: In the base case analysis, using CPAP effectiveness estimates form the ACUTE trial, the mean expected costs of standard care and prehospital CPAP were £15,201 and £14,850 respectively and the corresponding mean expected QALYs were 1.190 and 1.128, respectively. The mean ICER estimated as standard oxygen therapy compared to prehospital CPAP was £5685 per QALY which indicated that standard oxygen therapy strategy was likely to be cost-effective at a threshold of £20,000 per QALY (67% probability). The scenario analysis, using effectiveness estimates from an updated meta-analysis, suggested that prehospital CPAP was more effective (mean incremental QALYs of 0.157), but also more expensive (mean incremental costs of £1522), than standard care. The mean ICER, estimated as prehospital CPAP compared to standard care, was £9712 per QALY. At the £20,000 per QALY prehospital CPAP was highly likely to be the most cost-effective strategy (94%). CONCLUSIONS: Cost-effectiveness of prehospital CPAP depends upon the estimate of effectiveness. When based on a small pragmatic feasibility trial, standard oxygen therapy is cost-effective. When based on meta-analysis of heterogeneous trials, CPAP is cost-effective. Value of information analyses support commissioning of a large pragmatic effectiveness trial, providing feasibility and plausibility conditions are met.
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Authors: Abdullah Pandor; Praveen Thokala; Steve Goodacre; Edith Poku; John W Stevens; Shijie Ren; Anna Cantrell; Gavin D Perkins; Matt Ward; Jerry Penn-Ashman Journal: Health Technol Assess Date: 2015-06 Impact factor: 4.014
Authors: Patrick Ray; Sophie Birolleau; Yannick Lefort; Marie-Hélène Becquemin; Catherine Beigelman; Richard Isnard; Antonio Teixeira; Martine Arthaud; Bruno Riou; Jacques Boddaert Journal: Crit Care Date: 2006-05-24 Impact factor: 9.097
Authors: Gordon Fuller; Sam Keating; Steve Goodacre; Esther Herbert; Gavin Perkins; Andy Rosser; Imogen Gunson; Josh Miller; Matthew Ward; Mike Bradburn; Praveen Thokala; Tim Harris; Maggie Marsh; Alex Scott; Cindy Cooper Journal: BMJ Open Date: 2020-07-23 Impact factor: 2.692
Authors: Gordon W Fuller; Steve Goodacre; Samuel Keating; Gavin Perkins; Matthew Ward; Andy Rosser; Imogen Gunson; Joshua Miller; Mike Bradburn; Praveen Thokala; Tim Harris; Andrew Carson; Maggie Marsh; Cindy Cooper Journal: Pilot Feasibility Stud Date: 2018-06-18