학술논문
Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care.
Document Type
Academic Journal
Author
Moure-Fernandez A; Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK aidamoure@gmail.com.; School of Social and Community Medicine, University of Bristol, Bristol, UK.; Hollinghurst S; Centre for Academic Primary Care, University of Bristol, Bristol, UK.; Carroll FE; School of Social and Community Medicine, University of Bristol, Bristol, UK.; Downing H; Centre for Academic Primary Care, University of Bristol, Bristol, UK.; Young G; School of Social and Community Medicine, University of Bristol, Bristol, UK.; Brookes S; Population Health Sciences, University of Bristol, Bristol, UK.; May M; School of Social and Community Medicine, University of Bristol, Bristol, UK.; Population Health Sciences, University of Bristol, Bristol, UK.; El-Gohary M; Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.; Harnden A; Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.; Kendrick D; Division of Primary Care, University of Nottingham, Nottingham, UK.; Lafond N; Division of Primary Care, University of Nottingham, Nottingham, UK.; Little P; Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.; Moore M; Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK.; Orton E; Division of Primary Care, University of Nottingham, Nottingham, UK.; Thompson M; Department of Family Medicine, University of Washington, Seattle, Washington, USA.; Timmins D; Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.; Wang K; Nuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.; Hay AD; Centre for Academic Primary Care, University of Bristol, Bristol, UK.
Source
Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo.
Design: Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.
Setting: Fifty-four National Health Service (NHS) general practices in England.
Participants: 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.
Interventions: 2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets.
Outcome Measures: Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up.
Results: 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms.
Conclusions: The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms.
Trial Registration Numbers: EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.
Competing Interests: Competing interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Thompson reports that he has received funding from Alere Inc to conduct research on C-reactive protein point-of-care tests, has received funding from Roche Molecular Diagnostics for consultancy work.
(© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Design: Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.
Setting: Fifty-four National Health Service (NHS) general practices in England.
Participants: 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.
Interventions: 2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets.
Outcome Measures: Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up.
Results: 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms.
Conclusions: The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms.
Trial Registration Numbers: EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.
Competing Interests: Competing interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Thompson reports that he has received funding from Alere Inc to conduct research on C-reactive protein point-of-care tests, has received funding from Roche Molecular Diagnostics for consultancy work.
(© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)