Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial
Summary Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicent...
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| Veröffentlicht in: | Anaesthesia 2017-06, Vol.72 (6), p.704-713 |
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| creator | Dieleman, J. M. Wit, G. A. Nierich, A. P. Rosseel, P. M. Maaten, J. M. Hofland, J. Diephuis, J. C. Lange, F. Boer, C. Neslo, R. E. Moons, K. G. Herwerden, L. A. Tijssen, J. G. Kalkman, C. J. Dijk, D. |
| description | Summary
Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double‐blind, placebo‐controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra‐operative dose of dexamethasone 1 mg.kg−1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12‐month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72‐1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £−1672 to −137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality‐adjusted life year. We conclude that intra‐operative high‐dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness. |
| doi_str_mv | 10.1111/anae.13853 |
| format | Article |
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Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double‐blind, placebo‐controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra‐operative dose of dexamethasone 1 mg.kg−1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12‐month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72‐1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £−1672 to −137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality‐adjusted life year. We conclude that intra‐operative high‐dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.13853</identifier><identifier>PMID: 28317094</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Anesthesia ; Anti-Inflammatory Agents - administration & dosage ; Anti-Inflammatory Agents - economics ; Anti-Inflammatory Agents - therapeutic use ; Cardiac Surgical Procedures - methods ; Clinical outcomes ; Clinical trials ; Cost effectiveness ; Cost-Benefit Analysis ; Costs ; Dexamethasone ; Dexamethasone - administration & dosage ; Dexamethasone - economics ; Dexamethasone - therapeutic use ; Dosage ; Double-Blind Method ; Evidence-based medicine ; Female ; Heart ; Heart diseases ; Heart surgery ; Humans ; Incidence ; inflammation ; Intraoperative Period ; Length of Stay ; Male ; Middle Aged ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Quality-Adjusted Life Years ; Randomization ; Respiratory failure ; Respiratory Insufficiency - epidemiology ; Respiratory Insufficiency - prevention & control ; Steroids ; Surgery ; Survival Analysis ; Treatment Outcome</subject><ispartof>Anaesthesia, 2017-06, Vol.72 (6), p.704-713</ispartof><rights>2017 The Association of Anaesthetists of Great Britain and Ireland</rights><rights>2017 The Association of Anaesthetists of Great Britain and Ireland.</rights><rights>Copyright © 2017 The Association of Anaesthetists of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3933-aab348bb27439a3ee86de2d7b67adcd18401114d712a19c816f1fb4f8b494d4d3</citedby><cites>FETCH-LOGICAL-c3933-aab348bb27439a3ee86de2d7b67adcd18401114d712a19c816f1fb4f8b494d4d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.13853$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.13853$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28317094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dieleman, J. M.</creatorcontrib><creatorcontrib>Wit, G. A.</creatorcontrib><creatorcontrib>Nierich, A. P.</creatorcontrib><creatorcontrib>Rosseel, P. M.</creatorcontrib><creatorcontrib>Maaten, J. M.</creatorcontrib><creatorcontrib>Hofland, J.</creatorcontrib><creatorcontrib>Diephuis, J. C.</creatorcontrib><creatorcontrib>Lange, F.</creatorcontrib><creatorcontrib>Boer, C.</creatorcontrib><creatorcontrib>Neslo, R. E.</creatorcontrib><creatorcontrib>Moons, K. G.</creatorcontrib><creatorcontrib>Herwerden, L. A.</creatorcontrib><creatorcontrib>Tijssen, J. G.</creatorcontrib><creatorcontrib>Kalkman, C. J.</creatorcontrib><creatorcontrib>Dijk, D.</creatorcontrib><creatorcontrib>DExamethasone for Cardiac Surgery (DECS) Study Group</creatorcontrib><creatorcontrib>the DExamethasone for Cardiac Surgery (DECS) Study Group</creatorcontrib><title>Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double‐blind, placebo‐controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra‐operative dose of dexamethasone 1 mg.kg−1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12‐month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72‐1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £−1672 to −137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality‐adjusted life year. We conclude that intra‐operative high‐dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anti-Inflammatory Agents - administration & dosage</subject><subject>Anti-Inflammatory Agents - economics</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Cost effectiveness</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Dexamethasone</subject><subject>Dexamethasone - administration & dosage</subject><subject>Dexamethasone - economics</subject><subject>Dexamethasone - therapeutic use</subject><subject>Dosage</subject><subject>Double-Blind Method</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>inflammation</subject><subject>Intraoperative Period</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Quality-Adjusted Life Years</subject><subject>Randomization</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - epidemiology</subject><subject>Respiratory Insufficiency - prevention & control</subject><subject>Steroids</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90ctu1DAUBmALUdGhsOEBkCU2CCnFt8Q2u1FVLtKobGAdndjHM6mSeLCTwux4BJ6RJ6nLlC5Y4M3ZfPp1jn9CXnB2zst7CxPgOZemlo_IisumrgRT6jFZMcZkJRSzp-RpzteMcWG4eUJOhZFcM6tWZL-J0_b3z18zppHGZXZxxExh8tTFPFMMAd3c3-CEOdMY6K7f7gr3MSP1-ANGnHeQ44Q0xEQdJN-Do3lJW0yHdxRoKllx7DN6OqcehmfkJMCQ8fn9PCNf319-ufhYbT5_-HSx3lROWikrgE4q03VCK2lBIprGo_C6azR457lRrJyuvOYCuHWGN4GHTgXTKau88vKMvD7m7lP8tmCe27KEw2GACeOSW2605bbWtS701T_0Oi5pKtsVZRuhaylFUW-OyqWYc8LQ7lM_Qjq0nLV3PbR3PbR_eij45X3k0o3oH-jfjy-AH8H3fsDDf6La9dX68hh6C1pNlWM</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>Dieleman, J. M.</creator><creator>Wit, G. A.</creator><creator>Nierich, A. P.</creator><creator>Rosseel, P. M.</creator><creator>Maaten, J. M.</creator><creator>Hofland, J.</creator><creator>Diephuis, J. C.</creator><creator>Lange, F.</creator><creator>Boer, C.</creator><creator>Neslo, R. E.</creator><creator>Moons, K. G.</creator><creator>Herwerden, L. A.</creator><creator>Tijssen, J. G.</creator><creator>Kalkman, C. J.</creator><creator>Dijk, D.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201706</creationdate><title>Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial</title><author>Dieleman, J. M. ; Wit, G. A. ; Nierich, A. P. ; Rosseel, P. M. ; Maaten, J. M. ; Hofland, J. ; Diephuis, J. C. ; Lange, F. ; Boer, C. ; Neslo, R. E. ; Moons, K. G. ; Herwerden, L. A. ; Tijssen, J. G. ; Kalkman, C. 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J.</creatorcontrib><creatorcontrib>Dijk, D.</creatorcontrib><creatorcontrib>DExamethasone for Cardiac Surgery (DECS) Study Group</creatorcontrib><creatorcontrib>the DExamethasone for Cardiac Surgery (DECS) Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dieleman, J. M.</au><au>Wit, G. A.</au><au>Nierich, A. P.</au><au>Rosseel, P. M.</au><au>Maaten, J. M.</au><au>Hofland, J.</au><au>Diephuis, J. C.</au><au>Lange, F.</au><au>Boer, C.</au><au>Neslo, R. E.</au><au>Moons, K. G.</au><au>Herwerden, L. A.</au><au>Tijssen, J. G.</au><au>Kalkman, C. J.</au><au>Dijk, D.</au><aucorp>DExamethasone for Cardiac Surgery (DECS) Study Group</aucorp><aucorp>the DExamethasone for Cardiac Surgery (DECS) Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2017-06</date><risdate>2017</risdate><volume>72</volume><issue>6</issue><spage>704</spage><epage>713</epage><pages>704-713</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double‐blind, placebo‐controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra‐operative dose of dexamethasone 1 mg.kg−1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12‐month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72‐1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £−1672 to −137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality‐adjusted life year. We conclude that intra‐operative high‐dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>28317094</pmid><doi>10.1111/anae.13853</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Anaesthesia, 2017-06, Vol.72 (6), p.704-713 |
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| subjects | Adult Aged Anesthesia Anti-Inflammatory Agents - administration & dosage Anti-Inflammatory Agents - economics Anti-Inflammatory Agents - therapeutic use Cardiac Surgical Procedures - methods Clinical outcomes Clinical trials Cost effectiveness Cost-Benefit Analysis Costs Dexamethasone Dexamethasone - administration & dosage Dexamethasone - economics Dexamethasone - therapeutic use Dosage Double-Blind Method Evidence-based medicine Female Heart Heart diseases Heart surgery Humans Incidence inflammation Intraoperative Period Length of Stay Male Middle Aged Patients Postoperative Complications - epidemiology Postoperative Complications - prevention & control Quality-Adjusted Life Years Randomization Respiratory failure Respiratory Insufficiency - epidemiology Respiratory Insufficiency - prevention & control Steroids Surgery Survival Analysis Treatment Outcome |
| title | Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial |
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