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

Health economics
Table 11.11 Costs of treating infections due to test or implant procedures
Cost
Additional
length of
stay
reference
Minor infection Course of flucloxacillin oral
solution (125 mg/5 ml 100 ml)
Major infection Non-elective inpatient stay for
major infection without
complications (code PA16B)
£3.67 0 days BNFc 2010/11
£2623 4.61 days NHS reference
costs 2010/11
BNFc British National Formulary for Children
In the model if a patient develops a major infection during the surgery the pump will be removed. If the
pump fails to work they will have the pump removed. For some patients the pump will be implanted
but a problem is found that requires a second operation to fix. The costs of removing the pump or
having a second operation to correct a problem are reported in Table 11.12.
Table 11.12 Cost of removing the pump due to major infection (2010/11 prices)
Cost Inpatient stay Reference
Pump
removal
Cost of having
pump implanted
minus the cost
of the pump
£13,895 - £9706
= £4449
5 days Cost of implant procedure taken from
Sampson 2002. Cost of pump and
catheters taken from the East
Midlands Specialised Commissioning
Group – Commissioning Policy for
Intrathecal Baclofen 25/09/2009 and
uplifted to 2010/11 costs
Catheter
revision
or other
correction
2 nd operation
required to fix a
problem with the
pump
£4163 1.5 days Reference cost for catheter 18 years
or under
NHS reference costs 2010/11
Outcomes
No studies were identified that demonstrated the predictive value of the ITB test. Patients only had a
pump implanted if the test was positive. After discussion with the GDG it appears that clinicians are
able to predict which patients will benefit from ITB treatment from their clinical characteristics. The test
is used to demonstrate the effectiveness of ITB to the patient and help decide treatment goals.
The baseline analysis assumes no improvement in quality of life for children and young people who
have the pump implanted and this is the same effect as standard therapy, a conservative assumption
to reflect that little good quality comparative evidence is available. It is assumed that staying on
standard therapy resulted in no quality of life improvements, but also no deterioration.
The analysis was also run using the long-term quality of life effects from Sampson 2002 (see Tables
11.6 and 11.7).
Synthesis of costs and outcomes
The cost of care for a population of 100 children and young people was calculated for each arm (see
Tables 11.13, 11.14 and 11.15). Table 11.13 reports the number of specific events (test results,
adverse events) throughout the clinical pathway and the total cost for children who were tested prior
to planned treatment. Table 11.14 shows the same data for children who were not tested prior to
treatment and were identified as suitable to have an ITB pump based on clinical judgement alone.
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