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

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76 Results of the paediatric economic evaluation TABLE 60 Costs and outcomes by anaesthetic regimen in the paediatric study Anaesthetic Total variable No. of regimen cost for group patients with (mean per PONV patient) (£) Propofol/halothane 556.5 (3.5) 9 (5.6%) Sevoflurane/ sevoflurane 2021.2 (12.4) 24 (16.5%) Sensitivity analysis Uncertainty: CESA RCT data Clinical outcomes The impact of uncertainty around clinical outcomes was tested using a deterministic sensitivity analysis on the observed rate of PONV. In the deterministic sensitivity analysis, extreme values are taken for a named parameter individually, in order to examine the effects on the ICER found in the baseline analysis of the empirical study. The extreme (lower and upper) values for the probability of PONV were defined using 95% CIs around the observed PONV rate. Table 61 shows the results of a deterministic sensitivity analysis on the observed rate of PONV. The modelled baseline values for the ICERs TABLE 61 Deterministic sensitivity analysis on the rate of PONV in the paediatric study Parameter Anaesthetic regimen Propofol/ Sevoflurane/ halothane sevoflurane (n = 159) (n = 163) Mean cost per patient 4.6 14.8 with PONV (£) Mean cost per patient 3.5 12.0 with no PONV (£) Probability of PONV 0.06 0.15 (low 0.02; (low 0.10; high 0.10) high 0.20) Probability of no PONV 0.94 0.85 (= 1 – probability of PONV) Expected variable cost 3.69 12.42 per patient (£) (low 3.64; (low 12.28; high 3.74) high 12.56) closely match the values found in the empirical study. The two sets of values do not match exactly due to arithmetic rounding. This sensitivity analysis shows that the results of the empirical study are robust in terms of the observed PONV rate. Bootstrapped distributions of ICERs Bootstrapped distributions of the ICERs were generated for propofol/halothane compared with sevoflurane/sevoflurane (Figure 25). The costeffectiveness plane generated (2.5% and 97.5% percentiles –£32 and –£5, respectively) confirms the conclusion that propofol/halothane is the dominant arm. Substitution of isoflurane or sevoflurane for halothane The national survey suggested that the use of halothane in paediatric maintenance anaesthesia has declined (see chapter 3). It is likely that halothane will be, or is being, superseded by isoflurane or sevoflurane. Therefore, the impact of substituting isoflurane or sevoflurane in the propofol/ halothane regimen was investigated through simple modelling. It was not satisfactory to assume that a quantity (in millilitres) of one anaesthetic was equivalent to another (i.e. 5 ml sevoflurane is not equivalent to the administration of 5 ml halothane). To mirror actual practice as closely as possible, it was assumed that the clinical endpoint aimed for by administration of a volatile anaesthetic in the anaesthetic room or in the operating theatre determined the quantity of volatile anaesthetic given. It was thus assumed that an equivalent MAC of anaesthetic would be given to achieve that clinical endpoint, irrespective of the particular anaesthetic given. MACs of oxygen for children were obtained from the product datasheets and were used to provide a standard measure of the dose of volatile anaesthetic administered. The MACs used were 1.08% for halothane, 260 1.6% for isoflurane 260 and 2.4% for sevoflurane 260 (values for children). The following relationship was assumed: % Concentration of halothane administered/ MAC halothane = % Concentration [volatile 2] administered/ MAC [volatile 2] where volatile 2 was either isoflurane or sevoflurane. This relationship was used to convert the percentage concentration of halothane administered to the percentage concentration of sevoflurane and percentage concentration of isoflurane at each time interval.
1.80 The new variable cost and total cost per patient were calculated. The results are listed in Table 62. Derivation of ICERs There is no strong evidence to suggest that the PONV rates will differ between halothane, isoflurane or sevoflurane when these agents are given in conjunction with propofol (see chapter 2). Therefore, the outcomes were assumed to be the same as in the observed dataset. Table 63 shows the total variable costs and PONV rates for the groups for the observed and modelled alternatives. It can be seen that substituting halothane with isoflurane has a small effect on costs, but does not alter the conclusion that propofol with an inhalational © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 –0.20 –0.25 –0.20 –0.15 –0.10 –0.05 0 0.05 0.10 0.15 0.20 0.25 –2.20 –4.20 –6.20 –8.20 –10.20 –12.20 Difference in variable cost (increase in cost compared with sevoflurane/sevoflurane) (£) Effect size (decrease in probability of PONV with sevoflurane/sevoflurane) FIGURE 25 The cost-effectiveness plane for propofol/halothane versus sevoflurane/sevoflurane (the 2.5% and 97.5% percentile boundaries are indicated by the straight line from the origin) in the paediatric study TABLE 62 Sensitivity analysis: modelling the effect on costs of substituting isoflurane and sevoflurane for halothane in the paediatric study (n = 159) Cost Anaesthetic regimen Propofol/halothane, Propofol/isoflurane, Propofol/sevoflurane, observed costs modelled costs modelled costs Mean (SD) total cost (£) 84.0 (21.2) 84.8 (21.4) 93.5 (23.7) Mean (SD) variable cost (£) 3.5 (1.9) 4.4 (2.0) 13.0 (6.6) TABLE 63 Modelled costs and outcomes for the different anaesthetic regimens in the paediatric study Anaesthetic Total No. of regimen variable patients cost for with PONV group (%) (£) Propofol/halothane, observed 556.5 9 (5.6%) Sevoflurane/sevoflurane, observed 2021.2 24 (16.5%) Propofol/isoflurane, modelled 699.6 9 (5.6%) Propofol/sevoflurane, 2067.0 9 (5.6%) modelled 77
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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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24 Literature review (30%) and meth
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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 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: The mean CVs for avoidance of PONV
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
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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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126 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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