Cargando…

Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

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 along...

Descripción completa

Detalles Bibliográficos
Autores principales: Moure-Fernandez, Aida, Hollinghurst, Sandra, Carroll, Fran E, Downing, Harriet, Young, Grace, Brookes, Sara, May, Margaret, El-Gohary, Magdy, Harnden, Anthony, Kendrick, Denise, Lafond, Natasher, Little, Paul, Moore, Michael, Orton, Elizabeth, Thompson, Matthew, Timmins, David, Wang, Kay, Hay, Alastair D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045138/
https://www.ncbi.nlm.nih.gov/pubmed/32075830
http://dx.doi.org/10.1136/bmjopen-2019-033567
_version_ 1783501717357199360
author Moure-Fernandez, Aida
Hollinghurst, Sandra
Carroll, Fran E
Downing, Harriet
Young, Grace
Brookes, Sara
May, Margaret
El-Gohary, Magdy
Harnden, Anthony
Kendrick, Denise
Lafond, Natasher
Little, Paul
Moore, Michael
Orton, Elizabeth
Thompson, Matthew
Timmins, David
Wang, Kay
Hay, Alastair D
author_facet Moure-Fernandez, Aida
Hollinghurst, Sandra
Carroll, Fran E
Downing, Harriet
Young, Grace
Brookes, Sara
May, Margaret
El-Gohary, Magdy
Harnden, Anthony
Kendrick, Denise
Lafond, Natasher
Little, Paul
Moore, Michael
Orton, Elizabeth
Thompson, Matthew
Timmins, David
Wang, Kay
Hay, Alastair D
author_sort Moure-Fernandez, Aida
collection PubMed
description 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.
format Online
Article
Text
id pubmed-7045138
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-70451382020-03-09 Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care Moure-Fernandez, Aida Hollinghurst, Sandra Carroll, Fran E Downing, Harriet Young, Grace Brookes, Sara May, Margaret El-Gohary, Magdy Harnden, Anthony Kendrick, Denise Lafond, Natasher Little, Paul Moore, Michael Orton, Elizabeth Thompson, Matthew Timmins, David Wang, Kay Hay, Alastair D BMJ Open Health Economics 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. BMJ Publishing Group 2020-02-18 /pmc/articles/PMC7045138/ /pubmed/32075830 http://dx.doi.org/10.1136/bmjopen-2019-033567 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Economics
Moure-Fernandez, Aida
Hollinghurst, Sandra
Carroll, Fran E
Downing, Harriet
Young, Grace
Brookes, Sara
May, Margaret
El-Gohary, Magdy
Harnden, Anthony
Kendrick, Denise
Lafond, Natasher
Little, Paul
Moore, Michael
Orton, Elizabeth
Thompson, Matthew
Timmins, David
Wang, Kay
Hay, Alastair D
Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title_full Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title_fullStr Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title_full_unstemmed Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title_short Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
title_sort economic evaluation of the osac randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care
topic Health Economics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045138/
https://www.ncbi.nlm.nih.gov/pubmed/32075830
http://dx.doi.org/10.1136/bmjopen-2019-033567
work_keys_str_mv AT mourefernandezaida economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT hollinghurstsandra economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT carrollfrane economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT downingharriet economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT younggrace economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT brookessara economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT maymargaret economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT elgoharymagdy economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT harndenanthony economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT kendrickdenise economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT lafondnatasher economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT littlepaul economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT mooremichael economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT ortonelizabeth economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT thompsonmatthew economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT timminsdavid economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT wangkay economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare
AT hayalastaird economicevaluationoftheosacrandomisedcontrolledtrialoralcorticosteroidsfornonasthmaticadultswithacutelowerrespiratorytractinfectioninprimarycare