Cost-Effectiveness of Erythropoietin in Traumatic Brain Injury: A Multinational Trial-Based Economic Analysis
The EPO-TBI multi-national randomized controlled trial found that erythropoietin (EPO), when compared to placebo, did not affect 6-month neurological outcome, but reduced illness severity-adjusted mortality in patients with traumatic brain injury (TBI), making the cost-effectiveness of EPO in TBI un...
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| Veröffentlicht in: | Journal of neurotrauma 2019-09, Vol.36 (17), p.2541-2548 |
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| creator | Knott, Rachel J Harris, Anthony Higgins, Alisa Nichol, Alistair French, Craig Little, Lorraine Haddad, Samir Presneill, Jeffrey Arabi, Yaseen Bailey, Michael Cooper, D James Duranteau, Jacques Huet, Olivier Mak, Anne McArthur, Colin Pettilä, Ville Skrifvars, Markus B Vallance, Shirley Varma, Dinesh Wills, Judy Bellomo, Rinaldo |
| description | The EPO-TBI multi-national randomized controlled trial found that erythropoietin (EPO), when compared to placebo, did not affect 6-month neurological outcome, but reduced illness severity-adjusted mortality in patients with traumatic brain injury (TBI), making the cost-effectiveness of EPO in TBI uncertain. The current study uses patient-level data from the EPO-TBI trial to evaluate the cost-effectiveness of EPO in patients with moderate or severe TBI from the healthcare payers' perspective. We addressed the issue of transferability in multi-national trials by estimating costs and effects for specific geographical regions of the study (Australia/New Zealand, Europe, and Saudi Arabia). Unadjusted mean quality-adjusted life-years (QALYs; 95% confidence interval [CI]) at 6 months were 0.027 (0.020-0.034;
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| doi_str_mv | 10.1089/neu.2018.6229 |
| format | Article |
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< 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000-0.028;
= 0.04). Mean unadjusted costs (95% CI) were $US5668 (-9191 to -2144;
= 0.002) lower in the treatment group; controlling for baseline IMPACT-TBI score and regional heterogeneity reduced this difference to $2377 (-12,446 to 7693;
= 0.64). For a willingness-to-pay threshold of $US50,000 per QALY, 71.8% of replications were considered cost-effective. Therefore, we did not find evidence that EPO was significantly cost-effective in the treatment of moderate or severe TBI at 6-month follow-up.</description><identifier>ISSN: 0897-7151</identifier><identifier>EISSN: 1557-9042</identifier><identifier>DOI: 10.1089/neu.2018.6229</identifier><identifier>PMID: 30907230</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Clinical trials ; Cost analysis ; Economic analysis ; Erythropoietin ; Estimates ; Heterogeneity ; Medical prognosis ; Mortality ; Patients ; Population ; Quality of life ; Trauma ; Traumatic brain injury</subject><ispartof>Journal of neurotrauma, 2019-09, Vol.36 (17), p.2541-2548</ispartof><rights>Copyright Mary Ann Liebert, Inc. Sep 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c360t-d4b2f093d989b202386da35c6ad01dd888d791f5e98c7f6b418cc74dfebb2c6b3</citedby><cites>FETCH-LOGICAL-c360t-d4b2f093d989b202386da35c6ad01dd888d791f5e98c7f6b418cc74dfebb2c6b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30907230$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Knott, Rachel J</creatorcontrib><creatorcontrib>Harris, Anthony</creatorcontrib><creatorcontrib>Higgins, Alisa</creatorcontrib><creatorcontrib>Nichol, Alistair</creatorcontrib><creatorcontrib>French, Craig</creatorcontrib><creatorcontrib>Little, Lorraine</creatorcontrib><creatorcontrib>Haddad, Samir</creatorcontrib><creatorcontrib>Presneill, Jeffrey</creatorcontrib><creatorcontrib>Arabi, Yaseen</creatorcontrib><creatorcontrib>Bailey, Michael</creatorcontrib><creatorcontrib>Cooper, D James</creatorcontrib><creatorcontrib>Duranteau, Jacques</creatorcontrib><creatorcontrib>Huet, Olivier</creatorcontrib><creatorcontrib>Mak, Anne</creatorcontrib><creatorcontrib>McArthur, Colin</creatorcontrib><creatorcontrib>Pettilä, Ville</creatorcontrib><creatorcontrib>Skrifvars, Markus B</creatorcontrib><creatorcontrib>Vallance, Shirley</creatorcontrib><creatorcontrib>Varma, Dinesh</creatorcontrib><creatorcontrib>Wills, Judy</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><creatorcontrib>for the EPO-TBI Investigators and the ANZICS Clinical Trials Group</creatorcontrib><title>Cost-Effectiveness of Erythropoietin in Traumatic Brain Injury: A Multinational Trial-Based Economic Analysis</title><title>Journal of neurotrauma</title><addtitle>J Neurotrauma</addtitle><description>The EPO-TBI multi-national randomized controlled trial found that erythropoietin (EPO), when compared to placebo, did not affect 6-month neurological outcome, but reduced illness severity-adjusted mortality in patients with traumatic brain injury (TBI), making the cost-effectiveness of EPO in TBI uncertain. The current study uses patient-level data from the EPO-TBI trial to evaluate the cost-effectiveness of EPO in patients with moderate or severe TBI from the healthcare payers' perspective. We addressed the issue of transferability in multi-national trials by estimating costs and effects for specific geographical regions of the study (Australia/New Zealand, Europe, and Saudi Arabia). Unadjusted mean quality-adjusted life-years (QALYs; 95% confidence interval [CI]) at 6 months were 0.027 (0.020-0.034;
< 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000-0.028;
= 0.04). Mean unadjusted costs (95% CI) were $US5668 (-9191 to -2144;
= 0.002) lower in the treatment group; controlling for baseline IMPACT-TBI score and regional heterogeneity reduced this difference to $2377 (-12,446 to 7693;
= 0.64). For a willingness-to-pay threshold of $US50,000 per QALY, 71.8% of replications were considered cost-effective. Therefore, we did not find evidence that EPO was significantly cost-effective in the treatment of moderate or severe TBI at 6-month follow-up.</description><subject>Clinical trials</subject><subject>Cost analysis</subject><subject>Economic analysis</subject><subject>Erythropoietin</subject><subject>Estimates</subject><subject>Heterogeneity</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Patients</subject><subject>Population</subject><subject>Quality of life</subject><subject>Trauma</subject><subject>Traumatic brain 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Neurotrauma</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>36</volume><issue>17</issue><spage>2541</spage><epage>2548</epage><pages>2541-2548</pages><issn>0897-7151</issn><eissn>1557-9042</eissn><abstract>The EPO-TBI multi-national randomized controlled trial found that erythropoietin (EPO), when compared to placebo, did not affect 6-month neurological outcome, but reduced illness severity-adjusted mortality in patients with traumatic brain injury (TBI), making the cost-effectiveness of EPO in TBI uncertain. The current study uses patient-level data from the EPO-TBI trial to evaluate the cost-effectiveness of EPO in patients with moderate or severe TBI from the healthcare payers' perspective. We addressed the issue of transferability in multi-national trials by estimating costs and effects for specific geographical regions of the study (Australia/New Zealand, Europe, and Saudi Arabia). Unadjusted mean quality-adjusted life-years (QALYs; 95% confidence interval [CI]) at 6 months were 0.027 (0.020-0.034;
< 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000-0.028;
= 0.04). Mean unadjusted costs (95% CI) were $US5668 (-9191 to -2144;
= 0.002) lower in the treatment group; controlling for baseline IMPACT-TBI score and regional heterogeneity reduced this difference to $2377 (-12,446 to 7693;
= 0.64). For a willingness-to-pay threshold of $US50,000 per QALY, 71.8% of replications were considered cost-effective. Therefore, we did not find evidence that EPO was significantly cost-effective in the treatment of moderate or severe TBI at 6-month follow-up.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>30907230</pmid><doi>10.1089/neu.2018.6229</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Clinical trials Cost analysis Economic analysis Erythropoietin Estimates Heterogeneity Medical prognosis Mortality Patients Population Quality of life Trauma Traumatic brain injury |
| title | Cost-Effectiveness of Erythropoietin in Traumatic Brain Injury: A Multinational Trial-Based Economic Analysis |
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