PT  - JOURNAL ARTICLE
AU  - Richeal M Burns
AU  - Jane Wolstenholme
AU  - Sena Jawad
AU  - Nicola Williams
AU  - Matthew Thompson
AU  - Rafael Perera
AU  - Alastair D Hay
AU  - Carl Heneghan
AU  - Paul Little
AU  - Michael Moore
AU  - Gail Hayward
ED  - ,
TI  - Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study
AID  - 10.1136/bmjopen-2017-019184
DP  - 2018 Apr 01
TA  - BMJ Open
PG  - e019184
VI  - 8
IP  - 4
4099  - http://bmjopen.bmj.com/content/8/4/e019184.short
4100  - http://bmjopen.bmj.com/content/8/4/e019184.full
SO  - BMJ Open2018 Apr 01; 8
AB  - Objectives To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat.Design A UK-based, multicentre, two arm, individually randomised, double blind trial.Setting and population Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. Intervention: a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit.Main outcome Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost–utility analysis performed on an intention-to-treat cohort adopting a health payers perspective.Results Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was −0.00005 (95% CI −0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was −£6440 (95% CI −£132 151 to £126 335) and the median ICER was −£304 (IQR-£5816 to £3877); suggesting considerable uncertainty.Conclusions and relevance The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice.Trial registration number ISRCTN17435450; Post-results.