TY - JOUR T1 - Cost-effectiveness of intrapleural use of tissue plasminogen activator and DNase in pleural infection: Evidence from the MIST2 randomised controlled trial JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01550-2018 SP - 1801550 AU - Ramon Luengo-Fernandez AU - Erika Penz AU - Melissa Dobson AU - Ioannis Psallidas AU - Andrew J. Nunn AU - Nick A. Maskell AU - Najib M. Rahman Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/05/01/13993003.01550-2018.abstract N2 - The MIST2 trial showed that combined intrapleural use of tissue plasminogen activator (t-PA) and DNase was effective when compared to 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 Euros (€) and in 2016 prices.Mean annual costs were lowest in the tPA-DNase group (€10 605 for t-PA, €17 856 for DNase; €13 483 for placebo, €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 t-PA-DNase was compared to placebo, the incremental cost per life-year gained of t-PA-DNase was €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 cost-effectiveness of this promising combined intervention.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Luengo-Fernandez has nothing to disclose.Conflict of interest: Dr. Penz reports personal fees from AstraZeneca, personal fees from GlaxoSmithKline, personal fees from Boehringer Ingelheim, outside the submitted work.Conflict of interest: Miss Dobson has nothing to disclose.Conflict of interest: Dr. Psallidas reports and Dr Psallidas works as a Medical Science Director in Astrazeneca pharmaceutical company in a different scientific area not relevant with the manuscript.Conflict of interest: Dr. NUNN reports grants from Roche UK, during the conduct of the study.Conflict of interest: Dr. maskell has nothing to disclose.Conflict of interest: Dr. Rahman reports grants from Roche UK, during the conduct of the study. ER -