Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial

H E Campbell, E A Stokes, D Bargo, R F Logan, A Mora, R Hodge, A Gray, M W James, A J Stanley, S M Everett, A A Bailey, H Dallal, J Greenaway, C Dyer, C Llewelyn, T S Walsh, S P L Travis, M F Murphy, V Jairath, TRIGGER investigators, Brennan Kahan, Michael Greaves, Bob Walt, Marc Turner, Keith Wheatley, Chris Hawkey, Duncan Wyncoll, Jonathan Benger, Caroline Doré, Cliff Gorton, Sarah Meredith, H E Campbell, E A Stokes, D Bargo, R F Logan, A Mora, R Hodge, A Gray, M W James, A J Stanley, S M Everett, A A Bailey, H Dallal, J Greenaway, C Dyer, C Llewelyn, T S Walsh, S P L Travis, M F Murphy, V Jairath, TRIGGER investigators, Brennan Kahan, Michael Greaves, Bob Walt, Marc Turner, Keith Wheatley, Chris Hawkey, Duncan Wyncoll, Jonathan Benger, Caroline Doré, Cliff Gorton, Sarah Meredith

Abstract

Objectives: Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB.

Setting: Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery.

Participants: 936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds.

Primary and secondary outcome measures: Healthcare resource use during hospitalisation and postdischarge up to 28 days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28 days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level.

Results: Mean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million.

Conclusions: AUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB.

Trial registration number: ISRCTN85757829 and NCT02105532.

Keywords: HEALTH ECONOMICS.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Distribution of patient responses across levels for each of the five EQ-5D domains. ▪ Level 1—no problems; ▪ level 2—some problems; ▪ level 3—extreme problems.

References

    1. Crooks C, Card T, West J. Reductions in 28-day mortality following hospital admission for upper gastrointestinal hemorrhage. Gastroenterology 2011;141:62–70. 10.1053/j.gastro.2011.03.048
    1. Parker DR, Luo X, Jalbert J et al. . Impact of upper and lower gastrointestinal blood loss on healthcare utilization and costs: a systematic review. J Med Econ 2011;14:279–87. 10.3111/13696998.2011.571328
    1. Kahan BC, Jairath V, Murphy MF et al. . Update on the transfusion in gastrointestinal bleeding (TRIGGER) trial: statistical analysis plan for a cluster-randomised feasibility trial. Trials 2013;14:206 10.1186/1745-6215-14-206
    1. Jairath V, Kahan BC, Gray A et al. . Restrictive vs liberal blood transfusion for acute upper gastrointestinal bleeding: rationale and protocol for a cluster randomized feasibility trial. Transfus Med Rev 2013;27:146–53. 10.1016/j.tmrv.2013.04.001
    1. Jairath V, Kahan BC, Gray A et al. . Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding: pragmatic, cluster randomised feasibility trial. Lancet 2014. In Press.
    1. Department of Health. NHS National Schedule of Reference Costs 2012–13. (accessed 12 Jan 2014).
    1. NHS Blood and Transplant. Price list 2012/2013. NHS Blood and Transplant, 2012.
    1. Department of Health Commercial Medicines Unit. Electronic Market Information Tool. (accessed 12 Jan 2014).
    1. Curtis L. Unit costs of health and social care 2013. Canterbury: Personal and Social Services Research Unit University of Kent, 2013.
    1. Bovill D. Patterns of pay: estimates from the Annual Survey of Hours and Earnings, UK, 1997 to 2013. (accessed 1 May 2014).
    1. Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53–72. 10.1016/0168-8510(96)00822-6
    1. Dolan P, Gudex C, Kind P et al. . A social tariff for EuroQol: results from a UK General Population Survey (Discussion Paper No. 138). York, England: Centre for Health Economics University of York, 1995.
    1. Dolan P. Modeling valuations for EuroQol health states. Med Care 1997;35:1095–108. 10.1097/00005650-199711000-00002
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med 2011;30:377–99. 10.1002/sim.4067
    1. Briggs A, Clark T, Wolstenholme J et al. . Missing…presumed at random: cost-analysis of incomplete data. Health Econ 2003;12:377–92. 10.1002/hec.766
    1. Ng ES-W, Diaz-Ordaz K, Grieve R et al. . Multilevel models for cost-effectiveness analyses that use cluster randomised trial data: an approach to model choice. Stat Methods Med Res 2013. Published Online First 10.1177/0962280213511719
    1. Gomes M, Ng ES-W, Grieve R et al. . Developing appropriate methods for cost-effectiveness analysis of cluster randomized trials. Med Decis Making 2012;32:350–61. 10.1177/0272989X11418372
    1. Rockall TA, Logan RF, Devlin HB et al. . Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. BMJ 1995;311:222–6. 10.1136/bmj.311.6999.222
    1. Office for National Statistics. Population estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2012. (accessed 6 Jun 2014).
    1. Hearnshaw SA, Logan RFA, Lowe D et al. . Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011;60:1327–35. 10.1136/gut.2010.228437
    1. Szende A, Janssen B. Population norms for the EQ-5D. In: Szende A, Janssen B, Cabases J, eds. Self-reported population health: an international perspective based on EQ-5D. New York: Springer, 2014:19–30.
    1. National Audit Office. Healthcare across the UK: a comparison of the NHS in England, Scotland, Wales and Northern Ireland. London: The Stationary Office, 2012.
    1. Jairath V, Kahan BC, Logan RFA et al. . Outcomes following acute nonvariceal upper gastrointestinal bleeding in relation to time to endoscopy: results from a nationwide study. Endoscopy 2012;44:723–30. 10.1055/s-0032-1309736
    1. Leontiadis GI, Sreedharan A, Dorward S et al. . Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess Rep 2007;11:1–164.
    1. Díaz-Ordaz K, Kenward MG, Grieve R. Handling missing values in cost effectiveness analyses that use data from cluster randomized trials. J R Stat Soc A 2014;177:457–74. 10.1111/rssa.12016

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel