Cost-effectiveness of Erythropoietin in Traumatic Brain Injury (EPO-TBI): A multinational trial based economic analysis
Journal of Neurotrauma
Knott RJ1, Harris A1, Higgins A2, Nichol A2,3,4, French C5,6, Little L2, Haddad S2,7, Presneill J2,3,8, Arabi Y2,9, Bailey M2, Cooper DJ2,3, Duranteau J10, Huet O2,11, Mak A2,3, McArthur C2,12, Pettilä V2,13, Skrifvars MB13, Vallance S2,3, Varma D3, Wills J2,3, Bellomo R2,5,6,14.
1 Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia.
2 Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
3 The Alfred, Melbourne, Victoria, Australia.
4 University College Dublin-Clinical Research Centre, St Vincent’s University Hospital, Dublin, Ireland.
5 Western Health, Melbourne, Victoria, Australia.
6 University of Melbourne, Melbourne, Victoria, Australia.
7 King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
8 University of Queensland and Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia.
9 King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center Riyadh, Kingdom of Saudi Arabia.
10 Département d’Anesthésie-Réanimation, Hôpital de Bicêtre, Assistance Publique des Hopitaux de Paris, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Paris, France.
11 Department of Anaesthesiology and Intensive Care Medicine, CHU La Cavale Blanche, Brest, France.
12 Auckland City Hospital, Auckland, New Zealand.
13 University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
14 Austin Hospital, Melbourne, Victoria, Australia
Year of Publication:
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.