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Costing day case anesthesia: obtaining accurate patient-based costs for adults and children

Published online by Cambridge University Press:  01 November 2004

Rachel A. Elliott ,
Linda M. Davies ,
Katherine Payne ,
Julia K. Moore  and
Nigel J. N. Harper
Rachel A. Elliott
Affiliation:
University of Manchester
Linda M. Davies
Affiliation:
University of Manchester
Katherine Payne
Affiliation:
University of Manchester
Julia K. Moore
Affiliation:
University of Manchester
Nigel J. N. Harper
Affiliation:
University of Manchester
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Abstract

Objectives: This study proposes the method requirements for a valid costing study in anesthesia to allow differences to be identified between treatments and uses these method requirements to design and conduct a robust costing study.

Methods: A prospective, patient-based costing study was carried out in adult and pediatric day surgery in the United Kingdom. The perspective was that of the National Health Service and the patient. Data were collected for each patient until 7 days after hospital discharge.

Results: Data were collected for 1,063 adults and 322 children undergoing day surgery between October 1999 and January 2001. Statistically significant differences were found only between variable costs, which accounted for 11.4 percent and 9.0 percent of adult and pediatric costs, respectively. There were no differences in length of stay, fixed costs, or semi-fixed costs. Differences were not found in total costs in adults but were found in children. By day 7, postdischarge primary and secondary care costs were not different between groups in either study. No differences were found in costs to patients or parents.

Conclusions: The use of prospective, patient-based cost data enabled the detection of differences in variable costs between difference anesthetic regimens in day surgery. The stochastic nature of the data provided a measure of variability around mean cost estimates. Practice patterns in the study reflected normal practice in the United Kingdom so the costing data have direct clinical relevance. The use of different anesthetic agents only affected variable costs and had no effect on larger cost drivers such as length of stay or staff input.

Keywords

Economic evaluationAnesthesiaCosting methodology
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 552 - 561
Copyright
© 2004 Cambridge University Press

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References

Anon. 2000. Nurses' pay from April 1 2000. London: RCN Publishers
Barber J, Thompson SG. 2000 Analysis of cost data in randomised trials: An application of the non-parametric bootstrap. Stat Med. 19: 3219– 3236.Google Scholar
Beck EJ, Beecham J, Mandalia S, et al. 1999 What is the cost of getting the price wrong? J Public Health Med. 21: 311– 317.Google Scholar
Briggs AH, Gray AM. 1998 The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 3: 233– 245.Google Scholar
Broadway PJ, Jones JG. 1995 A method of costing anaesthetic practice. Anaesthesia. 50: 56– 63.Google Scholar
Churnside RJ, Glendenning GA. 1998 Resource use in general anaesthesia: A comparison of practice in Germany, France and the UK. J Drug Assess. 1: 403– 574.Google Scholar
UK Department of Health. 2002. Thousands of NHS patients to benefit from day surgery expansion-Hutton. Press release 2002/0354. London: Department of Health
Dexter F, Tinker HJ. 1995 Comparisons between desflurane and isoflurane or propofol on time to following commands and time to discharge. Anesthesiology. 83: 77– 82.Google Scholar
Dion P. 1992 The cost of anaesthetic vapours. Anaesthesia. 39: 633– 634.Google Scholar
Elliott RA, Payne K, Moore JK, et al. 2003 Clinical and economic choices in anaesthesia for day surgery: A prospective randomised controlled trial. Anaesthesia. 58: 412– 421.Google Scholar
Johnston K, Buxton MJ, Jones DR, Fitzpatrick R. 1999 Assessing the costs of healthcare technologies in clinical trials. Health Technol Assess. 3: 6.Google Scholar
Moore E, Pollard B, Elliott R. 2002 Anaesthetic agents in paediatric day case surgery: Do they affect outcome? Eur J Anaesthesiol. 19: 9– 17.Google Scholar
Pollard B, Elliott R, Moore E. 2003 Anaesthetic agents in adult day case surgery: Do they affect outcome? Eur J Anaesthesiol. 20: 1– 9.Google Scholar
HMSO. 2000. Review body on doctors and dentists remuneration. Twenty-ninth report. London: HMSO
Rowe WL. 1998 Economics and anaesthesia. Anaesthesia. 53: 782– 788.Google Scholar
SAS Institute Inc. 1989. SAS/STAT User's guide. Version 6, 4th ed. North Carolina: SAS Institute Inc
Schulman KA, Glick H, Buxton M, et al. 1996 The economic evaluation of the FIRST study: Design of a prospective analysis alongside a multinational phase III clinical trial. Control Clin Trials. 17: 304– 315.Google Scholar
Tolley K, Gyldmark M. 1993 The treatment and care costs of people with HIV infection or AIDS: Development of a standardised cost framework for Europe. Health Policy. 24: 55– 70.Google Scholar