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

More documents

Recommendations

Info

212 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
TABLE 85 Unit costs for the purchase of over-the-counter medicines by patients © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Over-the-counter product (generic medicine) Unit Unit cost 243 * (£) Anadin Extra ® (aspirin) 8 tablets 0.99 Anadin Soluble ® (aspirin) 8 tablets 1.19 Clarytin ® (loratidine) 7 tablets 4.25 Cocodamol 32 tablets 1.50 Cuprofen ® (ibuprofen) 12 tablets 1.45 ‘Dressing’ Melolin ® 5 dressings 1.05 Feminax ® 20 tablets 2.49 Ibuprofen 16 x 200 mg tablets 1.30 Junior Disprol ® (paracetamol) 16 tablets 1.25 Kaolin and morphine 200 mls 1.75 Motilum ® (domperidone) 10 tablets 3.95 Nurofen ® (ibuprofen) 12 tablets 1.59 Paracetamol 16 tablets 0.29 Paracodol ® (paracetamol, codeine) 12 tablets 1.99 Paramol ® (paracetamol, dihydrocodeine) 24 tablets 3.99 Peptobismol ® 120 mls 2.99 Potassium citrate 200 mls 1.22 Propain ® (paracetamol, codeine, diphenhydramine) 12 tablets 2.30 Rennies ® 8 tablets 0.61 Solpadol ® (paracetamol, codeine) 12 tablets 2.25 Strepsils ® * Personal communication. Manchester: High Street Pharmacy, 2000 TABLE 86 Unit costs of a GP visit 24 lozenges 2.05 Visit type Unit Unit cost (£) District nurse visit Per home visit 19.00 GP clinic consultation Per consultation of 9.36 min 17.00 GP home visit Per home visit of 13.2 min and 12 min travel time 42.00 GP receptionist consultation Per consultation of 10.8 min 1.85 GP telephone consultation Per consultation of 10.8 min 20.00 Health visitor Per home visit 29.00 Practice nurse visit Per consultation 9.00 Practice nurse visit Per home visit 17.00 213
Page 1 and 2:
Which anaesthetic agents are costef
Page 3:
Which anaesthetic agents are costef
Page 6 and 7:
NHS R&D HTA Programme The NHS R&D H
Page 8 and 9:
Contents Appendix 6 Adult patient-b
Page 11 and 12:
Background The aim of the project w
Page 13:
• The incidence of PONV was low d
Page 16 and 17:
2 Introduction dizziness or disorie
Page 18 and 19:
4 Introduction a reduced incidence
Page 20 and 21:
6 Introduction willingness to pay f
Page 22 and 23:
8 Literature review included in the
Page 24 and 25:
10 Literature review TABLE 1 Compar
Page 26 and 27:
12 Literature review intermediate a
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
18 Literature review Patient-based
Page 34 and 35:
20 Literature review TABLE 5 contd
Page 36 and 37:
22 Literature review No studies fol
Page 38 and 39:
24 Literature review (30%) and meth
Page 40 and 41:
26 Literature review • There are
Page 42 and 43:
28 National survey of anaesthetic p
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
36 Economic evaluation methods (inc
Page 52 and 53:
38 Economic evaluation methods The
Page 54 and 55:
40 Economic evaluation methods Tabl
Page 56 and 57:
42 Economic evaluation methods simi
Page 58 and 59:
44 Economic evaluation methods Prob
Page 61 and 62:
Recruitment to the CESA RCT The stu
Page 63 and 64:
Clinical outcome data PONV by anaes
Page 65 and 66:
The findings from the logistic regr
Page 67 and 68:
TABLE 29 The length of stay and pri
Page 69 and 70:
140 120 100 80 60 40 20 0 No. of pa
Page 71 and 72:
250 200 150 100 50 0 No. of patient
Page 73 and 74:
TABLE 37 Deterministic sensitivity
Page 75 and 76:
20 15 10 5 0 -5 Difference in varia
Page 77 and 78:
Patient admitted for day surgery an
Page 79 and 80:
500 400 300 200 100 0 -100 -200 -30
Page 81 and 82:
Recruitment to the CESA RCT The stu
Page 83 and 84:
TABLE 49 The occurrence of any PONV
Page 85 and 86:
60 50 40 30 20 10 0 No. of patients
Page 87 and 88:
a scale effect for scenario A, but
Page 89 and 90:
The mean CVs for avoidance of PONV
Page 91 and 92:
1.80 The new variable cost and tota
Page 93 and 94:
100 90 80 70 60 50 40 30 20 10 0 Su
Page 95 and 96:
The structure and content of this d
Page 97 and 98:
nurses to have an in-depth knowledg
Page 99 and 100:
agent used (see appendix 18). It wa
Page 101 and 102:
Furthermore, anaesthetists operate
Page 103 and 104:
The CESA project was designed to as
Page 105:
practice, such as the use of midazo
Page 109 and 110:
1. Royal College of Surgeons of Eng
Page 111 and 112:
60. Cheng KI, Chu KS, Fang YR, Su K
Page 113 and 114:
112. Raeder J, Gupta A, Pedersen FM
Page 115 and 116:
162. Viitanen H, Baer G, Annila P.
Page 117 and 118:
220. Rosenberg KM, Bridge P, Brown
Page 119 and 120:
The range of databases interrogated
Page 121:
24. preferen$.mp. [mp=title, abstra
Page 124 and 125:
110 Appendix 2 TABLE 65 contd Summa
Page 126 and 127:
112 Appendix 3 Quality assessment o
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 170 and 171:
Page 173 and 174:
TABLE 69 Summary of paediatric pati
Page 175 and 176: TABLE 69 contd Summary of paediatri
Page 177 and 178: TABLE 70 Characteristics of cost or
Page 179 and 180: TABLE 71 Quality of cost or economi
Page 181 and 182: TABLE 71 contd Quality of cost or e
Page 189 and 190: Abbott J, Abbott P. Psychological a
Page 191 and 192: Hall JE, Stewart JIM, Harmer M. Sin
Page 193: Struys M, Versichelen L, Thas O, He
Page 196 and 197: 182 Appendix 11
Page 205 and 206: The aim of this study was to develo
Page 207 and 208: anaesthetics in day surgery, using
Page 209: © Queen’s Printer and Controller
Page 213 and 214: Background The empirical study quan
Page 215 and 216: Satisfaction with care Nearly all (
Page 217 and 218: TABLE 76 Reason given for preferenc
Page 219 and 220: TABLE 79 Comparisons with previous
Page 221 and 222: TABLE 80 Reason given for preferenc
Page 223 and 224: TABLE 81 Reason given for willingne
Page 225: Background Variable costs account f
Page 229 and 230: Background The empirical study requ
Page 231 and 232: Ethical approval This was covered b
Page 233 and 234: 20 15 10 5 0 -5 -10 -15 True weight
Page 235: 15 10 5 0 -5 -10 True weight - Dion
Page 238 and 239: 224 Appendix 19 • patients aged o
Page 241 and 242: All staff unit costs were for the y
Page 243: Background Fixed costs account for
Page 246 and 247: 232 Appendix 22 March, Tuesday 15 A
Page 248 and 249: 234 Appendix 23 TABLE 96 Reasons fo
Page 251 and 252: Patients were coded using the OPCS
Page 253 and 254: Q03.4 punch biopsy of cervix Q03.5
Page 255 and 256: This section displays the associati
Page 257 and 258: given in Table 103 confirm the age
Page 259: TABLE 107 Occurrence of PONV by dur
Page 262 and 263: 248 Appendix 27 TABLE 113 Frequency
Page 265 and 266: This section displays the associati
Page 267 and 268: The adverse events observed in the
Page 269 and 270: 262 Health Technology Assessment Pr
Page 271: 264 Health Technology Assessment Pr
show all

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

Create successful ePaper yourself

Delete template?

Save as template?