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Economic analysis of oral dexamethasone for symptom relief of sore throat: The UK TOAST study

Economic analysis of oral dexamethasone for symptom relief of sore throat: The UK TOAST study
Economic analysis of oral dexamethasone for symptom relief of sore throat: The UK TOAST study

Objectives 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. Design A UK-based, multicentre, two arm, individually randomised, double blind trial. Setting and population Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. Intervention: A single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. Main outcome 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. Results 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. Conclusions and relevance 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.

cost-utility analysis, primary care, sore throat
2044-6055
Burns, Richeal M.
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Wolstenholme, Jane
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Jawad, Sena
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Williams, Nicola
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Thompson, Matthew
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Perera, Rafael
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Hay, Alastair D.
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Heneghan, Carl
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Little, Paul
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Moore, Michael
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Hayward, Gail
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Burns, Richeal M.
4a3e263c-0827-4077-8a3d-c46f70e14a9a
Wolstenholme, Jane
6452d0c9-354d-4e2b-a03c-e5f9d42212fe
Jawad, Sena
af2586a2-4d29-47b4-a604-0d138d0e87e9
Williams, Nicola
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Thompson, Matthew
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Perera, Rafael
e99a2819-c326-461c-8526-980b64458c22
Hay, Alastair D.
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Heneghan, Carl
ab54c700-8c86-420a-98b9-45e071b1c842
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Moore, Michael
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Hayward, Gail
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Burns, Richeal M., Wolstenholme, Jane, Jawad, Sena, Williams, Nicola, Thompson, Matthew, Perera, Rafael, Hay, Alastair D., Heneghan, Carl, Little, Paul, Moore, Michael and Hayward, Gail (2018) Economic analysis of oral dexamethasone for symptom relief of sore throat: The UK TOAST study. BMJ Open, 8 (4). (doi:10.1136/bmjopen-2017-019184).

Record type: Article

Abstract

Objectives 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. Design A UK-based, multicentre, two arm, individually randomised, double blind trial. Setting and population Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. Intervention: A single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. Main outcome 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. Results 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. Conclusions and relevance 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.

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More information

Accepted/In Press date: 15 February 2018
e-pub ahead of print date: 28 April 2018
Published date: April 2018
Keywords: cost-utility analysis, primary care, sore throat

Identifiers

Local EPrints ID: 427003
URI: https://eprints.soton.ac.uk/id/eprint/427003
ISSN: 2044-6055
PURE UUID: 0b7305af-6c4d-4428-8824-bef7d4029ee9
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 20 Dec 2018 17:30
Last modified: 14 Mar 2019 01:42

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