Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK

Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)

Mariamma M. Thalanany, Miranda Mugford, Clare Hibbert, Nicola J. Cooper, Ann Truesdale, Steven Robinson, Ravindranath Tiruvoipati, Diana R. Elbourne, Giles J. Peek, Felicity Clemens, Polly Hardy, Andrew Wilson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background. Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. Methods/Design. The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. Discussion. In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. Trial Registrations. The CESAR trial registration number is ISRCTN47279827.

Original languageEnglish (US)
Article number94
JournalBMC Health Services Research
Volume8
DOIs
StatePublished - 2008
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Cost-Benefit Analysis
Ventilation
Costs and Cost Analysis
Critical Care
Technology
Hospital Units
Quality-Adjusted Life Years
Hospital Costs
Public Sector
Health Care Costs
Uncertainty
Intensive Care Units
Publications
Therapeutics
Referral and Consultation
Randomized Controlled Trials
Economics
Interviews

ASJC Scopus subject areas

  • Health Policy

Cite this

Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK : Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR). / Thalanany, Mariamma M.; Mugford, Miranda; Hibbert, Clare; Cooper, Nicola J.; Truesdale, Ann; Robinson, Steven; Tiruvoipati, Ravindranath; Elbourne, Diana R.; Peek, Giles J.; Clemens, Felicity; Hardy, Polly; Wilson, Andrew.

In: BMC Health Services Research, Vol. 8, 94, 2008.

Research output: Contribution to journalArticle

Thalanany, Mariamma M. ; Mugford, Miranda ; Hibbert, Clare ; Cooper, Nicola J. ; Truesdale, Ann ; Robinson, Steven ; Tiruvoipati, Ravindranath ; Elbourne, Diana R. ; Peek, Giles J. ; Clemens, Felicity ; Hardy, Polly ; Wilson, Andrew. / Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK : Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR). In: BMC Health Services Research. 2008 ; Vol. 8.
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abstract = "Background. Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. Methods/Design. The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. Discussion. In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. Trial Registrations. The CESAR trial registration number is ISRCTN47279827.",
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AU - Hibbert, Clare

AU - Cooper, Nicola J.

AU - Truesdale, Ann

AU - Robinson, Steven

AU - Tiruvoipati, Ravindranath

AU - Elbourne, Diana R.

AU - Peek, Giles J.

AU - Clemens, Felicity

AU - Hardy, Polly

AU - Wilson, Andrew

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AB - Background. Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system. Methods/Design. The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated. Discussion. In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain. Trial Registrations. The CESAR trial registration number is ISRCTN47279827.

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