{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T08:35:07Z","timestamp":1776501307023,"version":"3.51.2"},"reference-count":23,"publisher":"European Respiratory Society (ERS)","issue":"2","license":[{"start":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.ersjournals.com\/user-licence"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2019,4,30]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>The MIST2 (Second Multicentre Intrapleural Sepsis Trial) trial showed that combined intrapleural use of tissue plasminogen activator (t-PA) and recombinant human DNase was effective when compared with single agents or placebo. However, the treatment costs are significant and overall cost-effectiveness of combined therapy remains unclear.<\/jats:p><jats:p>An economic evaluation of the MIST2 trial was performed to assess the cost-effectiveness of combined therapy. Costs included were those related to study medications, initial hospital stay and subsequent hospitalisations. Outcomes were measured in terms of life-years gained. All costs were reported in euro and in 2016 prices.<\/jats:p><jats:p>Mean annual costs were lowest in the t-PA\u2013DNase group (EUR 10\u200a605 for t-PA, EUR 17\u200a856 for DNase, EUR 13\u200a483 for placebo and EUR 7248 for t-PA\u2013DNase; p=0.209). Mean 1-year life expectancy was 0.988 for t-PA, 0.923 for DNase, and 0.969 for both placebo and t-PA\u2013DNase (p=0.296). Both DNase and placebo were less effective, in terms of life-years gained, and more costly than t-PA. When placebo was compared with t-PA\u2013DNase, the incremental cost per life-year gained of placebo was EUR 1.6 billion, with a probability of 0.85 of t-PA\u2013DNase being cost-effective.<\/jats:p><jats:p>This study demonstrates that combined t-PA\u2013DNase is likely to be highly cost-effective. In light of this evidence, a definitive trial designed to facilitate a thorough economic evaluation is warranted to provide further evidence on the cost-effectiveness of this promising combined intervention.<\/jats:p>","DOI":"10.1183\/13993003.01550-2018","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T21:16:08Z","timestamp":1558041368000},"page":"1801550","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":25,"title":["Cost-effectiveness of intrapleural use of tissue plasminogen activator and DNase in pleural infection: evidence from the MIST2 randomised controlled trial"],"prefix":"10.1183","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2118-2662","authenticated-orcid":false,"given":"Ramon","family":"Luengo-Fernandez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Penz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Dobson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Psallidas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Nunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick A.","family":"Maskell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najib M.","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"81","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"2024102100580186000_54.2.1801550.1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.156406"},{"key":"2024102100580186000_54.2.1801550.2","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.arcped.2007.06.008","article-title":"Epidemiology and clinical characteristics of childhood parapneumonic empyemas","volume":"14","author":"Desrumaux","year":"2007","journal-title":"Arch Pediatr"},{"key":"2024102100580186000_54.2.1801550.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.09.038"},{"key":"2024102100580186000_54.2.1801550.4","doi-asserted-by":"publisher","DOI":"10.1258\/rsmsmj.52.2.25"},{"key":"2024102100580186000_54.2.1801550.5","doi-asserted-by":"publisher","DOI":"10.1155\/2008\/975312"},{"key":"2024102100580186000_54.2.1801550.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042473"},{"key":"2024102100580186000_54.2.1801550.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"2024102100580186000_54.2.1801550.8","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2010.137000"},{"key":"2024102100580186000_54.2.1801550.9","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.160.5.9903002"},{"key":"2024102100580186000_54.2.1801550.10","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/89.4.285"},{"key":"2024102100580186000_54.2.1801550.11","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1513\/AnnalsATS.201608-594BC","article-title":"Safety and efficacy of tissue plasminogen activator and DNase for complicated pleural effusions secondary to abdominal pathology","volume":"14","author":"Majid","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2024102100580186000_54.2.1801550.12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/LBR.0000000000000334","article-title":"Mixing it up: coadministration of tPA\/DNase in complicated parapneumonic pleural effusions and empyema","volume":"24","author":"Bishwakarma","year":"2017","journal-title":"J Bronchology Interv Pulmonol"},{"key":"2024102100580186000_54.2.1801550.13","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1513\/AnnalsATS.201602-127OC","article-title":"Concurrent intrapleural instillation of tissue plasminogen activator and DNase for pleural infection. 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