Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis

Article English OPEN
Fenwick, E. ; Wilson, J. ; Sculpher, M.J. ; Claxton, K. (2002)

<b>Objective</b>: To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients. <b>Methods</b>: A cost-effectiveness analysis using data from a randomised controlled trial (RCT). In the RCT 138 patients undergoing major elective surgery were allocated to receive pre-operative optimisation employing either adrenaline or dopexamine (assigned randomly), or to receive routine peri-operative care. Differential health service costs were based on trial data on the number and cause of hospital in-patient days and the utilisation of health care resources. These were costed using unit costs from a UK hospital. The cost-effectiveness analysis related differential costs to differential life-years during a 2 year trial follow-up. <b>Results</b>: The mean number of in-patient days was 16 in the pre-optimised groups (19 adrenaline; 13 dopexamine) and 22 in the standard care group. The number (%) of deaths, over a 2 year follow-up, was 24 (26%) in the pre-optimised groups and 15 (33%) in the standard care group. The mean total costs were EUR 11,310 in the pre-optimised groups and EUR 16,965 in the standard care group. Life-years were 1.68 in the pre-optimised groups and 1.46 in the standard care group. The probability that pre-operative optimisation is less costly than standard care is 98%. The probability that it dominates standard care is 93%. Conclusions: Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment.
  • References (14)
    14 references, page 1 of 2

    1. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee T (1987) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176-1186

    2. Boyd O, Grounds RM, Bennett ED (1993) A randomised clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 270:2699-2707

    3. Wilson J, Woods I, Fawcett J, Whall R, Morris C, McManus E (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 318:1099-1103

    4. Guest JF, Boyd O, Hart WM, Grounds RM, Bennett ED (1997) A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients. Intensive Care Med 23:85-90

    5. British National Formulary (2000) British Medical Association and the Royal Pharmaceutical Society of Great Britain, London, Number 39, March, 2000

    6. Drummond MF, O'Brien BJ, Stoddart GL, Torrance GW (1997) Methods for the economic evaluation of health care programmes, 2nd edn. Oxford University Press, New York

    7. Black WC (1990) The CE plane: A graphic representation of cost-effectiveness. Med Decis Making 10:212- 214

    8. Fryback DG, Chinnis JO, Ulviva JW (2001) Bayesian cost-effectiveness analysis. An example using the GUSTO trial. Int J Technol Assess Health Care 17 (1):83-97

    9. Van Hout BA, Al MJ, Gordon GS, Rutten FFH (1994) Costs, effects and c/e-ratios alongside a clinical trial. Health Econ 3:309-319

    10. Briggs AH, Gray A (1999) Handling uncertainty when performing economic evaluation of healthcare interventions. Health Technol Assess 3:2

  • Metrics
    No metrics available
Share - Bookmark