Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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Appendix 17
• the patient had an outpatient appointment with
the consultant
• the patient telephoned the ward for advice.
Unit cost data
Unit costs for the year 2000 were attached to
the resource use. For hospital resource use the
NHS trust specific unit cost data were obtained
for drugs, disposable items and sundries, from
pharmacy and supplies departments. There was
little variation between the unit costs for drugs
and supplies between the two NHS trusts. The
unit costs from one of the two NHS trusts was
used in the baseline analysis.
Table 84 summarises the unit cost data for the
management of adverse events. For the management
of adverse events a unit cost of zero was
attached if:
• no action was taken
• drugs or fluids were given (because these were
already recorded and valued in ‘drug costs’)
• there was a change in fresh gas flows or volatile
anaesthetic concentration (because these
were already recorded and valued in
‘anaesthetic costs’)
• the patient had an overnight stay (because
these were already recorded and valued in
‘overnight stay’)
• the patient was kept on the ward longer
(because these were already recorded and
valued in ‘length of stay’)
• the patient developed laryngospasm or
hyperventilation (the patient would have
been monitored but the action taken did
not incur cost)
• the patient had excessive salivation (routine
suction would have been used but the action
taken did not incur cost)
• the patient bled from the wound (extra pressure
would have been applied to existing dressings
but the action taken did not incur cost).
TABLE 84 Unit costs for the management of adverse events
The unit cost of the smallest pack size of the
over-the-counter medicine was used to cost
medicines bought. Table 85 summarises these
unit cost data.
Each category of a GP ‘visit’ was assigned a unit
cost (Table 86), which reflected the time to complete
the ‘visit’ and the value, in terms of the
average salary per minute of the person involved.
The costs were obtained from a published source
and included the discounted value of training the
healthcare professional concerned. 244 The cost of
consulting a receptionist was valued by assuming
the average UK salary. 245 The cost of drugs
prescribed by the GP was valued using the British
National Formulary drug price, inclusive of VAT,
for a course of the named drugs, one tube of
cream or 1 week’s supply for maintenance therapy
(Table 87). Some drugs were not specifically
named, but the class of drug (e.g. antibiotic)
was recorded. In this situation an assumption was
made regarding the name of the drug and the
appropriate dose using the British National
Formulary (e.g. amoxicillin 250 mg capsules
for 5 days).
Each category of hospital visit was assigned a
unit cost from a published source (Table 88). 244
The cost of a telephone consultation was valued
assuming an E grade nurse took the call lasting
10.8 minutes.
Total variable cost
The total variable cost for hospital resource use
(i.e. the sum of drug, anaesthetic and adverseevent
variable costs) was calculated per patient.
The total variable cost was used in the baseline
analysis of the economic evaluation. The cost of
posthospital resource use was reported separately.
The posthospital resource cost excluded the cost of
the patient purchasing over-the-counter medicines.
Management of adverse events Unit Unit cost (£)
New laryngeal mask inserted Cost of laryngeal mask/number of times
re-used (40) + processing costs
2.92
Visit by surgeon or anaesthetist due to
adverse event
10.8 minute x salary + contributions 7.24
Patient vomited Laundry costs (sheets, pillow case, gown)
+ vomit bowl
0.94