Cost-effectiveness analysis of Intravascular Temperature Management after cardiac arrest in England

Abstract

Background: Although there is recognized that Targeted Temperature Management (TTM) can improve neurological outcomes and survival in patients resuscitated from out of hospital cardiac arrest, the cost-effectiveness of multiple methods of TTM is still uncertain. Objective: This study aimed to evaluate the cost-effectiveness of Intravascular Temperature Management (IVTM) through Thermogard XP in targeted temperature management compared to surface cooling method after cardiac arrest in England. Methods: We developed a multi-state Markov model that compared intravascular temperature management through Thermogard XP and the surface cooling method through two different devices including Blanketrol III and Arctic Sun 5000, over a short-term and lifetime horizon. Model input parameters were obtained from the literature and local databases. We assumed hypothetical cohort of 1,000 patients who need TTM after cardiac arrest per year in England. The outcomes were costs (in 2019 Pound Sterling) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results. Results: In a simulated cohort of 1,000 patients who need TTM, the Thermogard XP resulted in direct cost savings of 2,339 Pound and 2,925 Pound (per patient) when compared with Blanketrol III and Arctic Sun 5000 respectively, and a gain of 0.98 QALYs over the patient lifetime. Total cost saving considering cohort of 1,000 patients is 2,339,479 Pound and 2,925,109 Pound when using IVTM through Thermogard XP compared with Blanketrol III and Arctic Sun 5000 respectively in life-time horizon. Results were robust against alternative assumptions, changes in values of input parameters, and alternative time horizons. Conclusion: Implementation of intravascular temperature management using Thermogard XP can lead to cost-savings and improvement in patients quality of life versus surface cooling methods. Keywords: Cost-effectiveness analysis; Thermogard XP; targeted temperature management; surface cooling method; cardiac arrest