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 Is tight glycemic control (TGC) cost- effective for paediatrics in ICU?

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

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)

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

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)

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)

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