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

Fenwick, E., Wilson, J., Sculpher, M.J. and Claxton, K. (2002) Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis. Intensive Care Medicine, 28(5), pp. 599-608. (doi: 10.1007/s00134-002-1257-y)

Abstract

<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.

• Item Type: Articles
• Keywords: Resource use, Cost, Survival, Cost-effectiveness, Intensive care, Pre-operative care methods
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Fenwick, Professor Elisabeth and Claxton, Mr Karl
• Authors: Fenwick, E., Wilson, J., Sculpher, M.J., and Claxton, K.
• Subjects: R Medicine > RA Public aspects of medicine; R Medicine > RC Internal medicine; H Social Sciences > HG Finance
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Intensive Care Medicine
• Publisher: Springer
• ISSN: 1432-1238
• Copyright Holders: Copyright © 2002 Springer
• First Published: First published in Intensive Care Medicine 28(5):599-608
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher