Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

Objective To estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo. Design Cost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work. Setting Fifty-four National Health Service (NHS) general practices in England. Participants 398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days. Interventions 2 x 20 mg oral prednisolone per day for 5 days versus matching placebo tablets. Outcome measures Quality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up. Results 198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (13.11 pound vs 10.38) pound but without evidence of a difference (95% CI 3.05 pound to 8.52) pound. The trial medication cost of 1.96 pound per patient would have been recouped in prescription charges of 4.30 pound per patient overall (55% participants would have paid 7.85) pound, giving an overall mean 'profit' to the NHS of 7.00 pound (95% CI 0.50 pound to 17.08) pound per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms. Conclusions The use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and