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

List of abbreviations .................................. i
Executive summary .................................... iii
1 Introduction .................................................. 1
Day surgery .................................................... 1
Day-surgery anaesthesia and post-
anaesthetic recovery ...................................... 1
Anaesthetic practice in day surgery.............. 2
Choosing the optimal anaesthetic regimen .. 2
Current day-surgery anaesthetic practice .... 4
The rationale for an economic evaluation
of anaesthesia in day surgery ........................ 5
The rationale for a randomised controlled
trial design...................................................... 6
Aims and objectives of the study .................. 6
2 Literature review ........................................ 7
Aims and objectives of the review ................ 7
Search strategy .............................................. 7
Sources of evidence ...................................... 7
Quality assessment of the literature found .. 7
Clinical review ................................................ 8
Patient-based outcomes review .................... 18
Costs and cost-effectiveness of anaesthesia.... 23
Summary ........................................................ 25
3 National survey of anaesthetic practice
for paediatric and adult day surgery ........ 27
Introduction .................................................. 27
Method .......................................................... 27
Results ............................................................ 28
Implications for the empirical study ............ 32
Summary ........................................................ 34
4 Economic evaluation methods .................. 35
Aims and objectives ...................................... 35
Research questions ........................................ 35
Perspective...................................................... 35
Study design .................................................. 35
Patient population ........................................ 36
Comparators .................................................. 37
Time frame .................................................... 37
Recruitment and randomisation .................. 37
Measures ........................................................ 38
Costs................................................................ 39
Data ................................................................ 40
Data analysis .................................................. 40
Statistical analyses .......................................... 41
Sensitivity analysis .......................................... 42
CESA models.................................................. 43
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Contents
Health Technology Assessment 2002; Vol. 6: No. 30
5 Results of the adult economic
evaluation ...................................................... 47
Recruitment to the CESA RCT .................... 47
Patient characteristics.................................... 47
Clinical outcome data.................................... 49
Resource use data .......................................... 52
Patient preference and CV data .................. 53
Incremental cost-effectiveness ratios ............ 57
Sensitivity analysis .......................................... 58
Net benefit...................................................... 61
Summary ........................................................ 65
6 Results of the paediatric economic
evaluation ...................................................... 67
Recruitment to the CESA RCT .................... 67
Patient characteristics.................................... 67
Clinical outcome data.................................... 68
Resource use data .......................................... 70
Parent/guardian preferences and CV data .. 70
Incremental cost-effectiveness ratios ............ 75
Sensitivity analysis .......................................... 76
Net benefit .................................................... 78
Summary ........................................................ 79
7 Discussion...................................................... 81
Findings of the study .................................... 81
Problems encountered .................................. 82
Interpretation of the CESA RCT findings .. 84
8 Conclusions .................................................. 89
Implications for clinical practice .................. 89
Implications for future research .................. 90
Acknowledgements .................................... 93
References .................................................... 95
Appendix 1 Literature search strategies .... 105
Appendix 2 Meta-analyses of adult
clinical outcomes studies .............................. 109
Appendix 3 Quality criteria for
published studies .......................................... 111
Appendix 4 Adult clinical outcomes
studies ............................................................ 113
Appendix 5 Paediatric clinical
outcomes studies............................................ 139