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

Stokes, Elizabeth A.; Lazaroo, Michelle J.; Clout, Madeleine; Brett, Stephen J.; Black, Sarah; Kirby, Kim; Nolan, Jerry P.; Reeves, Barnaby C.; Robinson, Maria; Rogers, Chris A.; Scott, Lauren J.; Smartt, Helena; South, Adrian; Taylor, Jodi; Thomas, Matthew; Voss, Sarah; Benger, Jonathan R.; Wordsworth, Sarah

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 six-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 six 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 six 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.

• Journal Article Type: Article
• Acceptance Date: Jun 10, 2021
• Online Publication Date: Jun 10, 2021
• Publication Date: Oct 1, 2021
• Deposit Date: Nov 2, 2021
• Publicly Available Date: Nov 2, 2021
• Journal: Resuscitation
• Print ISSN: 0300-9572
• Electronic ISSN: 1873-1570
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 167
• Pages: 1-9
• DOI: https://doi.org/10.1016/j.resuscitation.2021.06.002
• Keywords: Cardiology and Cardiovascular Medicine; Emergency; Emergency Medicine
• Public URL: https://uwe-repository.worktribe.com/output/8044630
• Additional Information: This article is maintained by: Elsevier; Article Title: 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; Journal Title: Resuscitation; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.resuscitation.2021.06.002; Content Type: article; Copyright: © 2021 The Authors. Published by Elsevier B.V.