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

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64 Results of the adult economic evaluation TABLE 40 Comparison of the variable cost per patient from the empirical study and the simulation for the adult study Anaesthetic Mean (SD) variable cost (£) regimen Empirical study Simulation Propofol/propofol 21.1 (12.2) 21.7 (11.4) Propofol/sevoflurane 13.8 (11.7) 14.4 (8.1) Propofol/isoflurane 7.4 (4.4) 7.2 (4.0) Sevoflurane/sevoflurane 15.3 (6.8) 15.1 (5.6) groups (ANOVA, F (3,705), 5.34; p = 0.0012). The sevoflurane/sevoflurane group had a significantly lower net benefit than did the propofol/isoflurane and the propofol/ propofol groups (Tukey’s HSD test, p < 0.01) (Figure 16). Figure 17 shows the cumulative percentage of the net benefit/cost for each arm. The net cost was positive for around 15–25% of patients in the four study groups. TABLE 41 The results of the simulation for the case where all groups in the adult study receive prophylactic ondansetron Anaesthetic regimen Variable cost per patient Patients with PONV ICER (£/PONV (95% CI) (£) (95% CI) (%) instance avoided) Propofol/propofol 25.5 (24.7 to 26.3) 9.4 (6.4 to 12.4) 289 * Propofol/sevoflurane 17.7 (17.2 to 18.3) 12.1 (8.2 to 16.1) 3350 † Propofol/isoflurane 11.0 (10.7 to 11.2) 12.3 (8.2 to 16.4) – Sevoflurane/sevoflurane 18.9 (18.5 to 19.3) 20.3 (14.7 to 26.0) Dominated * Calculated with respect to the propofol/sevoflurane regimen † Calculated with respect to the propofol/isoflurane regimen TABLE 42 The results of the simulation for the case where all groups in the adult study except the propofol/propofol group receive prophylactic ondansetron Anaesthetic regimen Variable cost per patient Patients with PONV ICER (£/PONV (95% CI) (£) (95% CI) (%) instance avoided) * Propofol/propofol 21.1 13.9 (9.8 to 18.1) Dominated Propofol/sevoflurane 17.7 (17.2 to 18.3) 12.1 (8.2 to 16.1) 3350 Propofol/isoflurane 11.0 (10.7 to 11.2) 12.3 (8.2 to 16.4) – Sevoflurane/sevoflurane 18.9 (18.5 to 19.3) 20.3 (14.7 to 26.0) Dominated * Calculated with respect to the propofol/isoflurane regimen TABLE 43 Net cost (£) by anaesthetic regimen in the adult study (invalid answers excluded) Net cost Anaesthetic regimen Total (n = 709) Propofol/ Propofol/ Propofol/ Sevoflurane/ propofol isoflurane sevoflurane sevoflurane (n = 178) (n = 189) (n = 182) (n = 162) Mean (SD) total cost (£) 131.4 (88.9) 116.8 (79.8) 129.9 (99.3) 128.3 (72.8) 126.5 (85.8) Mean (SD) net benefit 50.8 (286.1) 106.6 (245.4) 38.7 (209.4) –23.3 (151.5) 45.6 (343.1) (induction only, Net[I]) Mean (SD) net benefit 324.5 (526.5) 265.8 (333.2) 271.3 (401.8) 185.1 (343.6) 263.0 (410.4) (maintenance only, Net[M]) Mean (SD) net benefit 507.3 (640.6) 489.1 (631.8) 440.8 (499.2) 289.0 (395.5) 435.5 (560.1) (induction and maintenance, Net[I + M])
500 400 300 200 100 0 –100 –200 –300 –400 –500 Net cost (£) Propofol/ propofol Propofol/ isoflurane Propofol/ sevoflurane Anaesthetic regimen FIGURE 16 The net cost for each anaesthetic regimen (limit 5% and 95% percentiles) in the adult study 100 90 80 70 60 50 40 30 20 10 0 Cumulative % Sevoflurane/ sevoflurane Health Technology Assessment 2002; Vol. 6: No. 30 Summary Recruitment The overall recruitment rate was 73%, and 95 patients were withdrawn, providing 1063 patients for the study. Fifteen per cent of patients were lost to follow-up 7 days after discharge. Clinical outcomes Adults had a statistically significantly higher incidence of PONV with sevoflurane/sevoflurane than with propofol/propofol. Sevoflurane/sevoflurane was significantly different from propofol/volatile, but the difference between propofol/propofol and propofol/volatile was not significant. The gender difference shown in previous studies was confirmed. The difference disappears with age and there was no gender difference in the paediatric study, and thus a premenopausal/ hormonal risk is implied. Additional risk factors associated with PONV are gynaecological surgery, agitation in recovery and duration of surgery. The overall overnight admission rate was nearly 9%, which is quite high. However, this was due in part to the urology patients. In these patients high admission rates can be justified in some circumstances, as the patient is booked as a day-case but FIGURE 17 The cumulative percentage of the net cost for each anaesthetic regimen in the adult study (– . – .,propofol/propofol; .....,propofol/isoflurane; –––, propofol/sevoflurane; – – –, sevoflurane/sevoflurane) © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Positive net benefit Positive net cost –2000 –1600 –1200 –800 –400 0 400 800 Net cost (£) 65
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Which anaesthetic agents are costef
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Which anaesthetic agents are costef
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NHS R&D HTA Programme The NHS R&D H
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Contents Appendix 6 Adult patient-b
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Background The aim of the project w
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• The incidence of PONV was low d
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2 Introduction dizziness or disorie
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4 Introduction a reduced incidence
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6 Introduction willingness to pay f
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8 Literature review included in the
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10 Literature review TABLE 1 Compar
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12 Literature review intermediate a
Page 28 and 29: 14 Literature review TABLE 3 Compar
Page 30 and 31: 16 Literature review TABLE 4 Compar
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 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: Patient admitted for day surgery an
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
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114 Appendix 4 TABLE 66 contd Summa
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TABLE 69 Summary of paediatric pati
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TABLE 69 contd Summary of paediatri
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TABLE 70 Characteristics of cost or
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TABLE 71 Quality of cost or economi
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TABLE 71 contd Quality of cost or e
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Abbott J, Abbott P. Psychological a
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Hall JE, Stewart JIM, Harmer M. Sin
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Struys M, Versichelen L, Thas O, He
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182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 Appendix 11
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The aim of this study was to develo
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anaesthetics in day surgery, using
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© Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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