The cost-effectiveness of adjunctive corticosteroids for patients with septic shock

• Published in: Critical care and resuscitation 2020-09, Vol.22 (3), p.191-199
• Main Authors: Thompson, Kelly J., Taylor, Colman B., Venkatesh, Balasubramanian, Cohen, Jeremy, Hammond, Naomi E., Jan, Stephen, Li, Qiang, Myburgh, John, Rajbhandari, Dorrilyn, Saxena, Manoj, Kumar, Ashwani, Finfer, Simon R.
• Format: Article
• Language: English
• Subjects: Evaluation; Intensive care units; Medical care, Cost of; Medical statistics; Original; Septic shock; Treatment
• ISSN: 1441-2772; 2652-9335
• DOI: 10.1016/S1441-2772(23)00386-1

Objective: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. Design: Data linkage-based cost-effectiveness analysis. Setting: New South Wales and Queensland intensive care units. Participants and intervention: Patients 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 measures: Health-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. Results: Of 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. Conclusions: Adjunctive 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.