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CHiP Collaborators’ Launch

CHiP Collaborators’ Launch. 10th December 2007 Economic evaluation Richard Grieve. Rationale. Want to provide effective interventions Resources in NHS (and elsewhere) are constrained NICE/ HTA other agencies recommend those interventions that are cost-effective

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CHiP Collaborators’ Launch

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  1. CHiP Collaborators’ Launch 10th December 2007 Economic evaluation Richard Grieve

  2. Rationale • Want to provide effective interventions • Resources in NHS (and elsewhere) are constrained • NICE/ HTA other agencies recommend those interventions that are cost-effective • Is tight glycemic control (TGC) cost-effective for paediatrics in ICU?

  3. Rationale • Van den Berge (2006) suggested in adults • Sub group >3 days in ICU • Reduced duration of mechanical ventilation • Reduced stay in ICU • Reduced stay in hospital • No information on cost/ cost-effectiveness

  4. Economic questions 1 1. Does the intervention increase 30 day hospital costs? • TGC: additional intervention costs? How big? • Reduction in other costs up to 30 days? • Reduced duration of mechanical ventilation? • Reduced duration of hospital stay? • (mean PICU cost=£1,384 bed-day)

  5. Economic questions 2,3 2. Does TGC reduce 1 year costs? • Initial admissions beyond 30 days • Transfers/ readmissions • Community health service use 3. Is TGC cost-effective? • 30 day costs and outcomes • 1 year costs and outcomes • e.g. cost per life year gained

  6. Methods (1) • Resource use during first 30 days • CRFs/PICANet • Duration of hospital stay • By Health Care Resource Groups (1-7) • Key interventions and medication use • Extra staff time in monitoring (site visits) • Staff time in managing adverse events • e.g. hypoglycemia (site visits)

  7. Methods (2) • Resource use after initial hospital discharge • Transfer/readmission forms • Postal questionnaires (iNNOVO 80% response) • Hospital readmissions • GP visits, community services • Unit costs from NHS Payment by results, (each day by HRG:1-7) • Costs at 30 day and 12 months (TBC vs conventional)

  8. Anticipated conclusions • Not just whether TGC effective? • But is it cost-effective? • no difference to outcomes, increased cost • Improves outcomes, at low additional cost • No difference outcomes, reduces costs • If finds resources (e.g. ventilator days) are ‘saved’ from TGC then they can be used elsewhere

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