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

80
Results of the paediatric economic evaluation
PONV 5.7%), compared with sevoflurane/
sevoflurane which was the least effective and
most costly (£12.40 per patient, rate of PONV
14.7%). The former alternative is therefore
the dominant arm.
Sensitivity analysis
• When the incidence of PONV was varied to its
95% CIs, the results of the baseline analysis for
the empirical study were shown to be robust
with respect to the observed PONV rate.
• Generation of a cost-effectiveness plane
demonstrated that the results of the baseline
analysis for the empirical study were robust
with respect to observed PONV rates and
variable costs.
• When halothane was substituted with isoflurane,
propofol/isoflurane was the most effective and
least costly regimen (£4.40 per patient, rate of
PONV 5.7%). Propofol/isoflurane is therefore
the dominant arm.
• When halothane was substituted with
sevoflurane, propofol/sevoflurane was the
most effective and most costly (£13.40 per
patient, rate of PONV 5.7%). The ICER
derived for propofol/sevoflurane compared
with sevoflurane/sevoflurane is £3.10 for each
PONV episode avoided.
• The use of the Dion algebraic approximation
for volatile-anaesthetic use resulted in a systematic
underestimation of the use of volatile
agents, although the estimation of a precise
inflation factor proved difficult. The impact
of this inflation factor continued to result
in propofol/halothane dominating the
sevoflurane/sevoflurane arm.
Net benefit
Both anaesthetic regimens had an overall negative
net cost, and the costs is each group were not
significantly different. The net cost was negative
for over 90% of patients in both study arms.