Bouras Marwan, Tessier Philippe, Poulain Cécile, Schirr-Bonnans Solène, Roquilly Antoine
Nantes Université, CHU Nantes, Service d'Anesthésie Réanimation, 44000, Nantes, France.
Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Inserm, CHU Nantes, 44000, Nantes, France.
J Intensive Care. 2024 Oct 11;12(1):40. doi: 10.1186/s40560-024-00753-z.
Interferon gamma‑1b has been proposed to treat critical illness-induced immunosuppression. We aimed to determine the effects on 90-day outcomes and the cost-effectiveness of interferon gamma‑1b compared to placebo in mechanically ventilated critically ill patients.
A cost-effectiveness analysis (CEA) was embedded in the "PREV-HAP trial", a multicenter, placebo‑controlled, randomized trial, which randomly assigned critically ill adults under mechanical ventilation to receive interferon gamma or placebo. The CEA compared interferon-gamma with placebo using a collective perspective at a 90-day time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed in terms of adjusted cost per adjusted Quality-Adjusted Life-Years (QALYs) gained. QALYs were estimated from the responses of patients and proxy respondents to the health-related quality of life questionnaire EQ-5D-3L.
The 109 patients in the PREV-HAP trial were included in the CEA. At day 90, all-cause mortality rates were 23.6% in the interferon group and 25% in the placebo group (Odds Ratio (OR) = 0.88 (0.40 -1.93) p = 0.67). The difference in the mean adjusted costs per patient at 90 days was €-1.638 (95%CI €-17.534 to €11.968) in favor of interferon gamma-1b. The mean difference in adjusted QALYs between interferon gamma-1b and the placebo group was + 0.019 (95%CI -0.005 to 0.043). The probability that interferon gamma-1b was cost-effective ranged from 0.60 to 0.71 for a willingness to pay a QALY between €20k and €150k for the base case analysis.
Early administration of interferon gamma might be cost-effective in critically ill patients supporting the realization of other studies on this treatment. However, the generalization of the findings should be considered cautiously, given the small sample size due to the premature end of PREV-HAP. Trial registration ClinicalTrials.gov Identifier: NCT04793568, Registration date: 2021-02-24.
有人提出使用干扰素γ-1b治疗危重病引起的免疫抑制。我们旨在确定与安慰剂相比，干扰素γ-1b对机械通气的危重病患者90天预后的影响及其成本效益。
在“PREV-HAP试验”中进行了一项成本效益分析（CEA），这是一项多中心、安慰剂对照的随机试验，将接受机械通气的成年危重病患者随机分配接受干扰素γ或安慰剂治疗。CEA从总体角度在90天的时间范围内比较了干扰素γ和安慰剂。主要结局是以每获得一个调整后的质量调整生命年（QALY）的调整成本表示的增量成本效益比（ICER）。QALY是根据患者和代理受访者对健康相关生活质量问卷EQ-5D-3L的回答估算得出的。
PREV-HAP试验中的109名患者被纳入CEA。在第90天，干扰素组的全因死亡率为23.6%，安慰剂组为25%（优势比（OR）=0.88（0.40-1.93），p=0.67）。90天时每位患者的平均调整成本差异为-1638欧元（95%置信区间为-17534欧元至11968欧元），有利于干扰素γ-1b。干扰素γ-1b与安慰剂组之间调整后的QALY平均差异为+0.019（95%置信区间为-0.005至0.043）。在基础病例分析中，对于每QALY支付意愿在2万欧元至15万欧元之间的情况，干扰素γ-1b具有成本效益的概率在0.60至0.71之间。
在危重病患者中早期使用干扰素γ可能具有成本效益，这支持了关于这种治疗方法的其他研究。然而，鉴于PREV-HAP试验提前结束导致样本量较小，应谨慎考虑研究结果的推广。试验注册ClinicalTrials.gov标识符：NCT04793568，注册日期：2021年2月24日。
