Burns Richeal M, Wolstenholme Jane, Jawad Sena, Williams Nicola, Thompson Matthew, Perera Rafael, Hay Alastair D, Heneghan Carl, Little Paul, Moore Michael, Hayward Gail
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Department of Medicine, Imperial College London, Neonatal Data Analysis Unit, London, UK.
BMJ Open. 2018 Apr 28;8(4):e019184. doi: 10.1136/bmjopen-2017-019184.
To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat.
A UK-based, multicentre, two arm, individually randomised, double blind trial.
Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care.
a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit.
Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective.
Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was -0.00005 (95% CI -0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was -£6440 (95% CI -£132 151 to £126 335) and the median ICER was -£304 (IQR-£5816 to £3877); suggesting considerable uncertainty.
The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice.
ISRCTN17435450; Post-results.
进行一项经济学分析，评估单剂量口服地塞米松与安慰剂相比缓解喉咙痛的成本效益。
一项基于英国的多中心、双臂、个体随机、双盲试验。
招募年龄≥18岁、患有急性喉咙痛且吞咽疼痛、病因判断为感染性的成年人，并在初级保健机构进行随机分组。
在初级保健就诊时给予单剂量10毫克口服地塞米松，并与安慰剂进行比较。
采用欧洲五维度五水平量表，在采用卫生支付者视角对意向性治疗队列进行成本效用分析时，估计增量成本效益比（ICER），即每质量调整症状缓解的成本。
观察到与安慰剂组相比，地塞米松组在基线后7天及24小时的健康相关生活质量（HRQoL）差异（分别高出2.9%和2.5%）。在控制基线HRQoL不平衡后，干预措施的经济影响无统计学意义：质量调整生命年差异为-0.00005（95%CI -0.0002至0.00011），相当于地塞米松组HRQoL损失半小时。在基础病例分析中，地塞米松组和安慰剂组每位患者的平均成本分别为73英镑和69英镑。在基础病例概率分析中，平均ICER为-6440英镑（95%CI -132151至126335英镑），中位数ICER为-304英镑（IQR -5816至3877英镑）；表明存在相当大的不确定性。
根据报告的资源使用情况和2015年英国单位成本，喉咙痛相关的经济负担巨大，估计对医疗服务支付者而言为23.5亿英镑。单剂量口服地塞米松作为一种治疗策略的成本效益存在相当大的不确定性，因此没有足够的证据支持其在临床实践中的使用。
ISRCTN17435450；结果公布后。
