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

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74 Results of the paediatric economic evaluation TABLE 57 The incidence of preference for a PONV risk of 7/10 (scenario C) or 3/10 (scenario D), by anaesthetic regimen in the paediatric study Anaesthetic regimen Total No. Preference Preference No Not Lost to of patients for scenario C for scenario D preference answered follow-up Total No. of patients 322 3 254 2 1 62 Propofol/halothane 159 2 129 1 1 – Sevoflurane/sevoflurane 163 1 125 1 0 – TABLE 58 CVs for maintenance anaesthesia with a PONV risk of 7/10 (scenario C) or 3/10 (scenario D), by anaesthetic regimen in the paediatric study (invalid answers excluded) Anaesthetic regimen No. who No. who Mean (SD) CV Mean (SD) CV x chose C chose D for D (£) 2.5 for D (£) Total No. of patients 3 236 237.7 (194) 594.5 (485) Propofol/halothane 2 120 222.4 (148) 556.1 (370) Sevoflurane/sevoflurane 1 116253.7 (232) 634.2 (579) 100 90 80 70 60 50 40 30 20 10 0 No. of patients 0 25 50 75 100 125 150 175 200 225 250 275 300 325 350 375 400 425 450 475 500 More CV (£) FIGURE 22 Distribution of CVs for avoidance of PONV after maintenance anaesthesia (scenario D) in the paediatric study
The mean CVs for avoidance of PONV were not significantly lower in the propofol/halothane group (p = 0.2633). The mean CV for those parents whose children suffered, and who did not suffer, PONV was £199.0 (SD = £117.4, n = 24) and £245.7 (SD = £208.7, n = 194) (p = 0.105). Therefore, the CV of parents was not affected by their experience of the clinical outcome. The conclusion was not altered when CVs were corrected by a factor of 2.5. Figure 22 shows the distribution of CVs for maintenance anaesthesia. It is clear that there is been a scale effect for scenario D. Reported income bands Table 59 summarises the reported monthly income bands of the parents of the participants in the paediatric study. There was no difference in income distribution between the randomisation arms. Income was not correlated with CVs (CVs for induction, Spearman’s ρ = 0.1305, p = 0.0590; CVs for maintenance, Spearman’s ρ = 0.1210, p = 0.080) (Figures 23 and 24). 600 500 400 300 200 100 0 Willingness to pay (£) < 250 250–500 501–1000 1001–2000 > 2000 Monthly household income (£) FIGURE 23 Willingness to pay for induction anaesthesia versus monthly household income (limit 5% and 95% percentiles) in the paediatric study © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 TABLE 59 Reported monthly household income bands of the parents of the participants in the paediatric study Monthly household income No. of patients > £2000 39 (12.4%) £1001 to £2000 97 (30.9%) £501 to £1000 63 (20.1%) £250 to £500 47 (15.0%) < £250 6 (1.9%) Income not given 8 (2.5%) Lost to follow-up 62 (19.7%) Incremental cost-effectiveness ratios In order to determine if there was a significant difference in the primary clinical outcome measure (frequency of PONV) it was necessary to derive the ICERs for the two randomisation arms. However, the cost of the more effective anaesthetic regimen is lower, and therefore propofol/halothane is the dominant arm (Table 60). The use of the propofol/halothane regimen reduced the variable costs by £1464.70 and the frequency of PONV by 15 episodes. 600 500 400 300 200 100 0 Willingness to pay (£) < 250 250–500 501–1000 1001–2000 > 2000 Monthly household income (£) FIGURE 24 Willingness to pay for maintenance anaesthesia versus monthly household income (limit 5% and 95% percentiles) in the paediatric study 75
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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
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18 Literature review Patient-based
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20 Literature review TABLE 5 contd
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22 Literature review No studies fol
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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
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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
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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
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Page 91 and 92: 1.80 The new variable cost and tota
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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
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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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124 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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