Abstract
The MIST2 (Second Multicentre Intrapleural Sepsis Trial) trial showed that combined intrapleural use of tissue plasminogen activator (t-PA) and recombinant human DNase was effective when compared with single agents or placebo. However, the treatment costs are significant and overall cost-effectiveness of combined therapy remains unclear.
An economic evaluation of the MIST2 trial was performed to assess the cost-effectiveness of combined therapy. Costs included were those related to study medications, initial hospital stay and subsequent hospitalisations. Outcomes were measured in terms of life-years gained. All costs were reported in euro and in 2016 prices.
Mean annual costs were lowest in the t-PA–DNase group (EUR 10 605 for t-PA, EUR 17 856 for DNase, EUR 13 483 for placebo and EUR 7248 for t-PA–DNase; p=0.209). Mean 1-year life expectancy was 0.988 for t-PA, 0.923 for DNase, and 0.969 for both placebo and t-PA–DNase (p=0.296). Both DNase and placebo were less effective, in terms of life-years gained, and more costly than t-PA. When placebo was compared with t-PA–DNase, the incremental cost per life-year gained of placebo was EUR 1.6 billion, with a probability of 0.85 of t-PA–DNase being cost-effective.
This study demonstrates that combined t-PA–DNase is likely to be highly cost-effective. In light of this evidence, a definitive trial designed to facilitate a thorough economic evaluation is warranted to provide further evidence on the cost-effectiveness of this promising combined intervention.
Abstract
The MIST2 trial showed that combined intrapleural use of t-PA and DNase was effective when compared with single agents or placebo in the treatment of pleural infection. This economic evaluation shows that t-PA–DNase is likely to be highly cost-effective. bit.ly/2vYZhWt
Footnotes
This article has supplementary material available from erj.ersjournals.com
Clinical trial: The MIST2 trial on which this study is based was registered at the ISRCTN registry with identifier ISRCTN57454527. No individual patient data will be made available. The study protocol is available on request.
Author contributions: R. Luengo-Fernandez performed the health economics analysis and wrote the first draft of the manuscript. E. Penz helped write the first draft of the manuscript and provided intellectual input for data interpretation. M. Dobson, I. Psallidas, A.J. Nunn, N.A. Maskell and N.M. Rahman were involved in either original data collection, subsequent intellectual input or manuscript writing All authors reviewed and approved the final manuscript.
Conflict of interest: R. Luengo-Fernandez has nothing to disclose.
Conflict of interest: E. Penz reports personal fees (participation in advisory boards) from AstraZeneca, GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work.
Conflict of interest: M. Dobson has nothing to disclose.
Conflict of interest: I. Psallidas works as a Medical Science Director in AstraZeneca in a different scientific area not relevant to the article.
Conflict of interest: A.J. Nunn reports an unrestricted educational grant from Roche UK, during the conduct of the study.
Conflict of interest: N.A. Maskell has nothing to disclose.
Conflict of interest: N.M. Rahman reports an unrestricted educational grant from Roche UK, during the conduct of the study.
Support statement: This work had no specific funding. The original trial was partly funded by an unrestricted educational grant from Roche UK and by others. A.J. Nunn's salary came through core funding MC_UU_12023/27 Tuberculosis Treatment Trials.
- Received September 10, 2018.
- Accepted April 30, 2019.
- Copyright ©ERS 2019
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