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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 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.

Original publication

DOI

10.1089/neu.2018.6229

Type

Journal

Journal of neurotrauma

Publication Date

09/2019

Volume

36

Pages

2541 - 2548

Addresses

Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia.

Keywords

Humans, Erythropoietin, Neuroprotective Agents, Treatment Outcome, Double-Blind Method, Quality-Adjusted Life Years, Adult, Middle Aged, Cost-Benefit Analysis, Patient Acceptance of Health Care, Female, Male, Young Adult, Brain Injuries, Traumatic