National Collaborating Centre for Women's and Children's Health

Spasticity in children and young people with non-progressive brain disorders
1999 Cost 2010/11 Cost
Min Max Mean
Cost of implantation procedure (cost of pump,
catheter, procedure, drugs, 5-day inpatient stay)
£8730–
£10,260
£12,776 £15,0152 £13,895
Other costs (tests, pathology, radiology,
microbiology) excluding potential transport
costs
Cost of follow-up (refill kit, drug costs,
physiotherapist assessment and outpatient visit)
average of 4 to 8 refills per year
£550 £805
£140–£150 £205 £220 £212
Procedure £11,743 £17,185
Follow-up 1 year £870 £1273
Total £15,420 £23,135
The cost per QALY for each category of patients was:
• Category 1 = £6900
• Category 2 = £12,790
• Category 3 = £8030
There was no comparator treatment in this study, therefore the results do not represent ICERs.
The conclusion of the study was that if the QALY gain was less than approximately 0.15 or if the cost
of CITB was above £19,000 over the 5 year period then the cost per QALY would be greater than the
NICE £20,000 threshold for willingness to pay for a QALY gain.
The published economic evaluation Sampson 2002 was used as the basis for developing a new
model which looked at the cost effectiveness of both testing and implanting the ITB pump.
Further analysis
Methods
The costs of testing, implanting the pump and follow-up visits over 5 years have been taken from
Sampson 2002 (see Table 11.7) and converted to 2010/11 costs (using the hospital and community
health services pay and prices index uplift [Curtis 2011]).
As the model runs over 5 years, costs and benefits accrued after the first year are discounted by 3.5%
for costs and 3.5% for benefits (1.5% tested for benefits). The perspective of this evaluation is from
the NHS, therefore only includes costs and benefits relevant to the NHS.
A treatment pathway was developed with the help of the GDG in which additional elements of
treatment were identified that were not included in the previous study (Sampson 2002). The main
change to the published model structure was the inclusion of a comparator treatment. It was assumed
that all patients would receive physiotherapy and so this was not included in the model.
In the model the following three comparisons were considered.
• Children and young people considered suitable candidates have a pre-screening
assessment and are tested before the pump is implanted. Patients who have a positive
test will go on to have the pump implanted. Patients who have a negative test will have
standard treatment.
• Children and young people considered suitable candidates by their clinicians have a
pre-screening assessment and get the pump implanted without a test dose.
272