Economic analysis of oral dexamethasone for symptom relief of sore throat: the UK TOAST study

BMJ Open. 2018 Apr 28;8(4):e019184. doi: 10.1136/bmjopen-2017-019184.


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.

Keywords: cost-utility analysis; primary care; sore throat.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Inflammatory Agents* / administration & dosage
  • Anti-Inflammatory Agents* / economics
  • Cost-Benefit Analysis
  • Dexamethasone* / administration & dosage
  • Dexamethasone* / economics
  • Double-Blind Method
  • England
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pharyngitis* / drug therapy
  • Quality of Life
  • Quality-Adjusted Life Years
  • Young Adult


  • Anti-Inflammatory Agents
  • Dexamethasone