Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study. Issue 4 (28th April 2018)

• Record Type: Journal Article
• Authors: Burns, Richeal M; Wolstenholme, Jane; Jawad, Sena; Williams, Nicola; Thompson, Matthew; Perera, Rafael; Hay, Alastair D; Heneghan, Carl; Little, Paul; Moore, Michael; Hayward, Gail
• Other Names: author non-byline.; M Voysey author non-byline.; J Cook author non-byline.; J Allen author non-byline.; K Harman author non-byline.
• Is Part Of: BMJ open. Volume 8:Issue 4(2018)
• Publication Date: 2018-04-28
• Subjects: cost-utility analysis -- primary care -- sore throat; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-019184
• Languages: English
• ISSNs: 2044-6055

Abstract

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. Trial registration number: ISRCTN17435450 ; Post-results.