Evidence map›Paper›PMID 32075830›Full record

Trial reportBMJ open2020

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

Aida Moure-Fernandez, Sandra Hollinghurst, Fran E Carroll, Harriet Downing, Grace Young, Sara Brookes, Margaret May, Magdy El-Gohary, Anthony Harnden, Denise Kendrick and 8 more

Registry-linked trialOpen access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06472219 (Early Prednisolone for Suspected Community-acquired Acute Respiratory Tract Infection), which is not on this map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06472219 phase3recruitingnot on this mapstarted 2024, after this paper: background citation

Early Prednisolone for Suspected Community-acquired Acute Respiratory Tract Infection (PREDICATE): A Double-blind, Randomised, Multi-centre, Adaptive Platform, Controlled Trial

TypeinterventionalSponsorThe University of Hong KongRan2024 to 2028Enrolled1,300ConditionsRespiratory Tract InfectionsArmsPrednisolone 30 mg, Placebo
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 5 institutions in 2 countries.

Aida Moure-FernandezBristol Randomised Trials Collaboration, University of Bristol, Bristol, UK aidamoure@gmail.com.
Sandra HollinghurstCentre for Academic Primary Care, University of Bristol, Bristol, UK.
Fran E CarrollSchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Harriet DowningCentre for Academic Primary Care, University of Bristol, Bristol, UK.
Grace YoungSchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Sara BrookesPopulation Health Sciences, University of Bristol, Bristol, UK.
Margaret MaySchool of Social and Community Medicine, University of Bristol, Bristol, UK.ORCID 0000-0002-9733-1003
Magdy El-GoharyDepartment of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
Anthony HarndenNuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.
Denise KendrickDivision of Primary Care, University of Nottingham, Nottingham, UK.
Natasher LafondDivision of Primary Care, University of Nottingham, Nottingham, UK.
Paul LittleDepartment of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
Michael MooreDepartment of Primary Care and Population Sciences, University of Southampton, Southampton, UK.
Elizabeth OrtonDivision of Primary Care, University of Nottingham, Nottingham, UK.
Matthew ThompsonDepartment of Family Medicine, University of Washington, Seattle, Washington, USA.
David TimminsNuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.
Kay WangNuffield Department of Primay Care Health Sciences, University of Oxford, Oxford, UK.
Alastair D HayCentre for Academic Primary Care, University of Bristol, Bristol, UK.
University of Bristol · GBUniversity of Nottingham · GBUniversity of Oxford · GBUniversity of Southampton · GBUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo 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.

designCost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.

settingFifty-four National Health Service (NHS) general practices in England.

participants398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.

interventions2× 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.

results198 (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 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean 'profit' to the NHS of £7.00 (95% CI £0.50 to £17.08) 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.

conclusionsThe 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 possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms. TRIAL REGISTRATION NUMBERS: EudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.

Indexed as

Cost-Benefit AnalysisDrug CostsQuality-Adjusted Life YearsAcute DiseaseAdministration, OralAdrenal Cortex HormonesAdultAnti-Inflammatory AgentsAsthmaCost SavingsCoughDrug PrescriptionsEnglandFemaleGeneral PracticeHumansAdrenal Cortex HormonesAnti-Inflammatory AgentsPrednisoloneALRTIcost-effectivenesshealth economicsprimary carerespiratory medicine (see thoracic medicine)

Identifiers

PMID32075830
PMCPMC7045138
OpenAlexW3005346652

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.