Long-term costs and cost-effectiveness of adjunctive corticosteroids for patients with septic shock in New Zealand

Kelly J Thompson; Paul J Young; Balasubramanian Venkatesh; Jeremy Cohen; Simon R Finfer; Sarah Grattan; Naomi E Hammond; Stephen Jan; Qiang Li; Gian Luca Di Tanna; Colin McArthur; John Myburgh; Dorrilyn Rajbhandari; Colman B Taylor

doi:10.1016/j.aucc.2021.05.006

Long-term costs and cost-effectiveness of adjunctive corticosteroids for patients with septic shock in New Zealand

Aust Crit Care. 2022 May;35(3):241-250. doi: 10.1016/j.aucc.2021.05.006. Epub 2021 Jul 26.

Authors

Affiliations

¹ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia.
² Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.
³ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; The Princess Alexandra Hospital, University of Queensland, Brisbane, Australia; The Wesley Hospital, Brisbane, Australia.
⁴ The George Institute for Global Health, Sydney, Australia.
⁵ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Imperial College, London, UK; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
⁶ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
⁷ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁸ Medical Research Institute of New Zealand, Wellington, New Zealand; Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
⁹ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia; St George Clinical School, University of New South Wales, Sydney, Australia.
¹⁰ The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia. Electronic address: ctaylor@georgeinstitute.org.au.

PMID: 34325975
DOI: 10.1016/j.aucc.2021.05.006

Abstract

Objective: The aim of the study was to determine whether adjunctive hydrocortisone reduced healthcare expenditure and was cost-effective compared with placebo in New Zealand patients in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial.

Design: This is a health economic analysis using data linkage to New Zealand Ministry of Health databases to determine resource use, costs, and cost-effectiveness for a 24-month period.

Setting: The study was conducted in New Zealand.

Participants and intervention: Patients with septic shock were randomised to receive a 7-day continuous infusion of 200 mg of hydrocortisone or placebo in the ADRENAL trial.

Main outcome measures: Healthcare expenditure was associated with all hospital admissions, emergency department presentations, outpatient visits, and pharmacy expenditure. Effectiveness outcomes included mortality at 6 months and 24 months and quality of life at 6 months. Cost-effectiveness outcomes were assessed with reference to quality-adjusted life years gained at 6 months and life years gained at 24 months.

Results: Of 3800 patients in the ADRENAL trial, 419 (11.0%) were eligible, and 405 (96.7% of those eligible) were included. The mean total costs per patient over 24 months were $143,627 ± 100,890 and $143,772 ± 97,117 for the hydrocortisone and placebo groups, respectively (p = 0.99). Intensive care unit costs for the index admission were $50,492 and $62,288 per patient for the hydrocortisone and placebo groups, respectively (p = 0.09). The mean number of quality-adjusted life years gained at 6 months and mean number of life years gained at 24 months was not significantly different by treatment group, and the probability of hydrocortisone being cost-effective was 55% at 24 months.

Conclusions: In New Zealand, adjunctive hydrocortisone did not reduce total healthcare expenditure or improve outcomes compared with placebo in patients with septic shock.

Keywords: Corticosteroids; Cost-effectiveness analysis; Economic evaluation; Intensive care medicine; Sepsis; Septic shock.

Publication types

Randomized Controlled Trial

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Cost-Benefit Analysis
Humans
Hydrocortisone / therapeutic use
New Zealand
Quality of Life
Shock, Septic* / drug therapy

Substances

Adrenal Cortex Hormones
Hydrocortisone