Faculty of Medicine, University of Southampton, Southampton, UK.
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
Qual Life Res. 2023 Oct;32(10):2987-2999. doi: 10.1007/s11136-023-03442-w. Epub 2023 Jun 7.
We conducted a health economic sub-study within a feasibility RCT comparing a non-operative treatment pathway as an alternative to appendicectomy for the treatment of uncomplicated acute appendicitis in children. The objectives were to understand and assess data collection tools and methods and to determine indicative costs and benefits assessing the feasibility of conducting a full economic evaluation within the definitive trial.
We compared different methods of estimating treatment costs including micro-costing, hospital administrative data (PLICS) and health system (NHS) reference costs. We compared two different HRQoL instruments (CHU-9D and EQ-5D-5L) in terms of data completeness and sensitivity to change over time, including potential ceiling effects. We also explored how the timing of data collection and duration of the analysis could affect QALYs (Quality Adjusted Life Years) and the results of the cost-utility analysis (CUA) within the future RCT.
Using a micro-costing approach, the total per treatment costs were in alignment with hospital administrative data (PLICS). Average health system reference cost data (macro-costing using NHS costs) could potentially underestimate these treatment costs, particularly for non-operative treatment. Costs incurred following hospital discharge in the primary care setting were minimal, and limited family borne costs were reported by parents/carers. While both HRQoL instruments performed relatively well, our results highlight the problem of ceiling effect and the importance of the timing of data collection and the duration of the analysis in any future assessment using QALYs and CUA.
We highlighted the importance of obtaining accurate individual-patient cost data when conducting economic evaluations. Our results suggest that timing of data collection and duration of the assessment are important considerations when evaluating cost-effectiveness and reporting cost per QALY.
Current Controlled Trials ISRCTN15830435.
我们在一项比较非手术治疗途径与阑尾切除术治疗儿童单纯性急性阑尾炎的可行性 RCT 中进行了健康经济学子研究。目的是了解和评估数据收集工具和方法，并确定指示性成本和效益，以评估在确定性试验中进行全面经济评估的可行性。
我们比较了不同的治疗成本估算方法，包括微观成本、医院行政数据（PLICS）和卫生系统（NHS）参考成本。我们比较了两种不同的 HRQoL 工具（CHU-9D 和 EQ-5D-5L）在数据完整性和随时间变化的敏感性方面的差异，包括潜在的天花板效应。我们还探讨了数据收集的时间和分析的持续时间如何影响 QALYs（质量调整生命年）和未来 RCT 中的成本效用分析（CUA）的结果。
使用微观成本法，每种治疗方法的总治疗成本与医院行政数据（PLICS）一致。平均卫生系统参考成本数据（使用 NHS 成本进行宏观成本）可能会低估这些治疗成本，特别是对于非手术治疗。在初级保健环境中出院后的住院费用较低，父母/照顾者报告的家庭负担费用有限。虽然两种 HRQoL 工具的表现都相对较好，但我们的结果强调了天花板效应的问题，以及在使用 QALYs 和 CUA 进行任何未来评估时，数据收集的时间和分析的持续时间的重要性。
我们强调了在进行经济评估时获取准确的个体患者成本数据的重要性。我们的结果表明，数据收集的时间和评估的持续时间是评估成本效益和报告每 QALY 成本的重要考虑因素。
当前对照试验 ISRCTN80316358。
