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Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer |
Harding V, Fenu E, Medani H, Shaboodien R, Ngan S, Li HK, Burt R, Diamantis N, Tuthill M, Blagden S, Gabra H, Urch CE, Moser S, Agarwal R |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The aim was to asses the cost-effectiveness of day-patient paracentesis, compared with in-patient paracentesis, for women with ovarian cancer. The authors concluded that day-patient treatment was feasible and cost-effective, for patients with malignant ascites. Several elements of the study were not well reported, and there were a few limitations, so the authors’ conclusions should be considered with caution. Type of economic evaluation Cost-effectiveness analysis Study objective The objective was to assess the cost-effectiveness of day-patient paracentesis, compared with in-patient paracentesis, for women with ovarian cancer. Interventions Paracentesis involved inserting a catheter at a drain site, marked by ultrasound in a radiology unit, and leaving it unclamped. For day patients, the procedure was done in the radiology unit, before 10.00am, and the patient was returned to the day unit, where they remained until 4.00pm, at which point the drain was removed (if draining was complete) and they were discharged home. If draining was incomplete or the patient developed any symptoms, they were admitted to hospital. For in-patients, the procedure was completed by a junior doctor on a ward. Methods Analytical approach:The evaluation was based on one clinical study of consecutive admissions to a hospital in Hammersmith, London, UK. The time horizon of the analysis was the immediate intervention period. The authors did not explicitly state the study perspective. Effectiveness data:The evidence came from a clinical study of 31 of the 67 patients who were admitted to a hospital in England, between July and October 2009. The follow-up period was until the patient was discharged following completion of the procedure. The main clinical effectiveness estimate was the complete ascites drainage, without complication or need for hospital admission. Monetary benefit and utility valuations:Not relevant. Measure of benefit:The main measure of benefit was the percentage of patients with complete ascites drainage, without complication or need for hospital admission. Cost data:The cost categories were the costs of staff for drain insertion (senior house officer or technician), and the hospital or day unit stay. The resource use and prices were from the National Schedule of Reference Costs for 2009 to 2010. All costs were reported in UK £. Analysis of uncertainty:The authors did not conduct any formal analysis of uncertainty. Results There were 18 in-patients, who underwent 21 procedures, and 13 day patients, who underwent 19 procedures. For in-patients, 17 (81%) drained completely (one who was accidentally clamped, was included), and for day patients, 18 (95%) drained completely. The estimated cost of day-patient paracentesis was £954, compared with £1,473 for in-patient paracentesis; a saving of £519 per procedure with day-patient paracentesis. Authors' conclusions The authors concluded that day-patient paracentesis was feasible and cost-effective, for patients with malignant ascites. CRD commentary Interventions:The interventions were well reported and included the usual clinical practice in a UK hospital, which was in-patient treatment. It is likely that these alternatives were relevant for other settings. Effectiveness/benefits:The source for the effectiveness estimates was described, and the inclusion criteria for the patients were reported. A subsample of patients was analysed, but confounding and selection bias were not accounted for, leaving the potential for bias in the results. The study population and results were reported in detail, but the design of the study was weak. It was unclear how generalisable these results were to other UK hospitals or other study settings. Costs:The categories of costs and the sources for the unit costs and resource quantities were reported, but more detail on the estimation of staff time costs would have been useful. No adjustments to the cost data were reported, but the year in which the resources were collected matched the price year, and the time horizon was short, so it is likely that no adjustments were necessary. Analysis and results:An incremental analysis was appropriate to compare the relative costs and effectiveness of the two methods of paracentesis, but the reporting of the methods and results was poor. The authors did not capture the impact of uncertainty in their analysis, and these results may not be generalisable to other settings. The authors did not consider the limitations of their analysis. Concluding remarks:Several elements of the study were not well reported, and there were a few limitations. The authors’ conclusions should be considered with caution. Funding Funded by a grant from the Imperial Healthcare Charity, UK. Bibliographic details Harding V, Fenu E, Medani H, Shaboodien R, Ngan S, Li HK, Burt R, Diamantis N, Tuthill M, Blagden S, Gabra H, Urch CE, Moser S, Agarwal R. Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer. British Journal of Cancer 2012; 107(6): 925-930 Indexing Status Subject indexing assigned by NLM MeSH Adult; Aged; Ambulatory Surgical Procedures /adverse effects /economics; Ascites /economics /etiology /radiography /surgery; Cost-Benefit Analysis; Disease Management; Feasibility Studies; Female; Great Britain; Humans; Length of Stay /statistics & London; Medical Records; Middle Aged; Ovarian Neoplasms /complications /economics; Palliative Care /methods; Paracentesis /adverse effects /economics /methods; Patient Safety; Retrospective Studies; Treatment Outcome; numerical data AccessionNumber 22012035069 Date bibliographic record published 31/01/2013 Date abstract record published 21/02/2013 |
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