The cost-effectiveness of early goal-directed therapy: an economic evaluation alongside the ARISE trial

Alisa M Higgins; Sandra L Peake; A O Rinaldo Bellomo; D Jamie Cooper Ao; Anthony Delaney; Belinda D Howe; Alistair D Nichol; Steve A Webb; Patricia J Williams; Anthony H Harris; ARISE Investigators and the ANZICS Clinical Trials Group

doi:10.51893/2021.3.OA10

The cost-effectiveness of early goal-directed therapy: an economic evaluation alongside the ARISE trial

Crit Care Resusc. 2023 Oct 18;23(3):329-336. doi: 10.51893/2021.3.OA10. eCollection 2021 Sep 6.

Authors

Alisa M Higgins¹, Sandra L Peake^{1

2}, A O Rinaldo Bellomo^{1

3}, D Jamie Cooper Ao^{1

4}, Anthony Delaney^{1

5

6}, Belinda D Howe¹, Alistair D Nichol^{1

4

7}, Steve A Webb^{1

8}, Patricia J Williams^{1

2}, Anthony H Harris⁹; ARISE Investigators and the ANZICS Clinical Trials Group

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
² University of Adelaide and Queen Elizabeth Hospital, Adelaide, SA, Australia.
³ Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
⁴ Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
⁵ Royal North Shore Hospital and University of Sydney, Sydney, NSW, Australia.
⁶ Division of Critical Care, The George Institute for Global Health, Sydney, NSW, Australia.
⁷ School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.
⁸ Royal Perth Hospital and University of Western Australia, Perth, WA, Australia.
⁹ Centre for Health Economics, Monash University, Melbourne, VIC, Australia.

Abstract

Objective: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock. Design: Within-trial cost-effectiveness evaluation. Setting: Nineteen hospitals in Australia and New Zealand. Participants and interventions: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation. Outcome measures: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective. Results: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, -$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%. Conclusions: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective. Clinical trial registration:ClinicalTrials.gov number NCT00975793.

Associated data

ClinicalTrials.gov/NCT00975793