Cost-effectiveness of erythropoietin in traumatic brain injury: a multinational trial-based economic analysis

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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; p < 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000–0.028; p = 0.04). Mean unadjusted costs (95% CI) were $US5668 (−9191 to −2144; p = 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; p = 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.
Original languageEnglish
Number of pages8
JournalJournal of Neurotrauma
DOIs
Publication statusAccepted/In press - 2019

Cite this

@article{8f59a687a99145c193bb434dd3015fe2,
title = "Cost-effectiveness of erythropoietin in traumatic brain injury: a multinational trial-based economic analysis",
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; p < 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000–0.028; p = 0.04). Mean unadjusted costs (95{\%} CI) were $US5668 (−9191 to −2144; p = 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; p = 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.",
author = "Knott, {Rachel J.} and Anthony Harris and Alisa Higgins and Alistair Nichol and Craig French and Lorraine Little and Samir Haddad and Jeffrey Presneill and Yaseen Arabi and Michael Bailey and Cooper, {D. James} and Jacques Duranteau and Olivier Huet and Anne Mak and Colin McArthur and Ville Pettila and Markus Skrifvars and Shirley Vallance and Dinesh Varma and Judy Wills and Rinaldo Bellomo and {For the EPO-TBI investigators and the ANZICS Clinical Trials Group}",
year = "2019",
doi = "10.1089/neu.2018.6229",
language = "English",
journal = "Journal of Neurotrauma",
issn = "0897-7151",
publisher = "Mary Ann Liebert Inc",

}

TY - JOUR

T1 - Cost-effectiveness of erythropoietin in traumatic brain injury

T2 - a multinational trial-based economic analysis

AU - Knott, Rachel J.

AU - Harris, Anthony

AU - Higgins, Alisa

AU - Nichol, Alistair

AU - French, Craig

AU - Little, Lorraine

AU - Haddad, Samir

AU - Presneill, Jeffrey

AU - Arabi, Yaseen

AU - Bailey, Michael

AU - Cooper, D. James

AU - Duranteau, Jacques

AU - Huet, Olivier

AU - Mak, Anne

AU - McArthur, Colin

AU - Pettila, Ville

AU - Skrifvars, Markus

AU - Vallance, Shirley

AU - Varma, Dinesh

AU - Wills, Judy

AU - Bellomo, Rinaldo

AU - For the EPO-TBI investigators and the ANZICS Clinical Trials Group

PY - 2019

Y1 - 2019

N2 - 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; p < 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000–0.028; p = 0.04). Mean unadjusted costs (95% CI) were $US5668 (−9191 to −2144; p = 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; p = 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.

AB - 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; p < 0.001) higher in the EPO group, with an adjusted QALY increment of 0.014 (0.000–0.028; p = 0.04). Mean unadjusted costs (95% CI) were $US5668 (−9191 to −2144; p = 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; p = 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.

U2 - 10.1089/neu.2018.6229

DO - 10.1089/neu.2018.6229

M3 - Article

JO - Journal of Neurotrauma

JF - Journal of Neurotrauma

SN - 0897-7151

ER -