Cost-effectiveness of the i-gel supraglottic airway device compared to tracheal intubation during out-of-hospital cardiac arrest: Findings from the AIRWAYS-2 randomised controlled trial

Elizabeth A. Stoke, Michelle J Lazaroo, Maddie J Clout, Chris A Rogers, Stephen J. brett, Sarah Black, South Western Ambulance Service NHS Foundation Trust UK, Jerry P Nolan, Barnaby C Reeves, Maria Robinson, Lauren J Scott, Helena J M Smartt, Jodi Taylor, Matthew A Thomas, Sarah Voss, University of the West of England Glenside Campus UK, Oxford NIHR Biomedical Research Centre UK*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Aim
Optimal airway management during out-of-hospital cardiac arrest (OHCA) is uncertain. Complications from tracheal intubation (TI) may be avoided with supraglottic airway (SGA) devices. The AIRWAYS-2 cluster randomised controlled trial (ISRCTN08256118) compared the i-gel SGA with TI as the initial advanced airway management (AAM) strategy by paramedics treating adults with non-traumatic OHCA. This paper reports the trial cost-effectiveness analysis.
Methods
A within-trial cost-effectiveness analysis of the i-gel compared with TI was conducted, with a 6-month time horizon, from the perspective of the UK National Health Service (NHS) and personal social services. The primary outcome measure was quality-adjusted life years (QALYs), estimated using the EQ-5D-5L questionnaire. Multilevel linear regression modelling was used to account for clustering by paramedic when combining costs and outcomes.
Results
9296 eligible patients were attended by 1382 trial paramedics and enrolled in the AIRWAYS-2 trial (4410 TI, 4886 i-gel). Mean QALYs to 6 months were 0.03 in both groups (i-gel minus TI difference -0.0015, 95% CI –0.0059 to 0.0028). Total costs per participant up to 6 months post-OHCA were £3570 and £3413 in the i-gel and TI groups respectively (mean difference £157, 95% CI –£270 to £583). Based on mean difference point estimates, TI was more effective and less costly than i-gel; however differences were small and there was great uncertainty around these results.
Conclusion
The small differences between groups in QALYs and costs shows no difference in the cost-effectiveness of the i-gel and TI when used as the initial AAM strategy in adults with non-traumatic OHCA.
Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalResuscitation
Volume167
Early online date11 Jun 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
The trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/167/102) and supported by the NIHR Comprehensive Research Networks. Professor Benger is a NIHR Senior Investigator. The trial was not funded by any commercial organisations or equipment manufacturers. The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health and Social Care.

Funding Information:
Rogers salary was funded by a grant from the B ritish Heart Foundation until March 2017; part of Reeves salary was funded by grants from the National Institute for Health Research. All other authors declare no conflicts of interest.

Funding Information:
The trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 12/167/102) and supported by the NIHR Comprehensive Research Networks. Professor Benger is a NIHR Senior Investigator. The trial was not funded by any commercial organisations or equipment manufacturers. The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS or the Department of Health and Social Care.Rogers salary was funded by a grant from the British Heart Foundationuntil March 2017; part of Reeves salary was funded by grants from the National Institute for Health Research. All other authors declare no conflicts of interest.

Publisher Copyright:
© 2021 The Authors

Keywords

  • Cost-effectiveness analysis
  • Out of hospital cardiac arrest
  • Airways management

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