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Economic evaluation of the OSAC randomised controlled trial: Oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

Carroll, Fran E.; Moure-Fernandez, Aida; Hollinghurst, Sandra; Downing, Harriet; Young, Grace; Brookes, Sara; May, Margaret; El-Gohary, Magdy; Harnden, Anthony; Kendrick, Denise; Lafond, Natasher; Little, Paul; Moore, Michael; Orton, Elizabeth; Thompson, Matthew; Timmins, David; Wang, Kay; Hay, Alastair D.

Authors

Fran E. Carroll

Aida Moure-Fernandez

Sandra Hollinghurst

Harriet Downing

Grace Young

Sara Brookes

Margaret May

Magdy El-Gohary

Anthony Harnden

DENISE KENDRICK denise.kendrick@nottingham.ac.uk
Professor of Primary Care Research

Natasher Lafond

Paul Little

Michael Moore

Matthew Thompson

David Timmins

Kay Wang

Alastair D. Hay



Abstract

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. Objective To estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo. Design Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work. Setting Fifty-four National Health Service (NHS) general practices in England. Participants 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days. Interventions 2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets. Outcome measures Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up. Results 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms. Conclusions The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms. Trial registration numbers EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.

Citation

Carroll, F. E., Moure-Fernandez, A., Hollinghurst, S., Downing, H., Young, G., Brookes, S., …Hay, A. D. (2020). Economic evaluation of the OSAC randomised controlled trial: Oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care. BMJ Open, 10(2), https://doi.org/10.1136/bmjopen-2019-033567

Journal Article Type Article
Acceptance Date Oct 15, 2019
Online Publication Date Feb 18, 2020
Publication Date Mar 18, 2020
Deposit Date Nov 20, 2019
Publicly Available Date Nov 26, 2019
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 10
Issue 2
Article Number e033567
DOI https://doi.org/10.1136/bmjopen-2019-033567
Keywords General Medicine
Public URL https://nottingham-repository.worktribe.com/output/3343296
Publisher URL https://bmjopen.bmj.com/content/10/2/e033567

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