Table 6-23Early versus late (>48h) surgery for hip fracture - Economic summary of findings

StudyIncremental cost (£)Incremental effects (QALYs)ICERUncertainty
NCGC decision model
  1. £1,000 for the first year of implementation of extra operating lists (a)
  2. £ 800 for the second year of implementation of extra operating lists (b)
  1. 0.0425 for the first year of implementation of extra operating lists
  2. 0.094 for the second year of implementation of extra operating lists (c)
  1. £22,542/QALY for the first year of implementation of extra operating lists
  2. £8,933/QALY for the second year of implementation of extra operating lists
95% CI: cost saving – dominated (both in the first and in the second year of implementation of extra operating lists (d)
a

In the first year of implementation of extra operating lists, the mean costs for investment in extra operating lists early surgery were £47.4, and for the non-investment strategy £46.4.

b

For the second year, the mean costs associated with the strategy of investment for early surgery were £47.3, and for the non-investment strategy £46.4.

c

In the first year of implementation of extra operating lists, the mean effectiveness for the strategy of investment for early surgery was 2.3637, and for the non-investment strategy 2.3212. In the second year, they corresponded to 2.415 and 2.321 respectively.

d

95% CI of ICERs calculated from the 10,000 Monte Carlo simulations. The high uncertainty of the model is due to all the types of variables, including the effectiveness of interventions. We have tested the uncertainty of all categories of inputs in the model (costs, utilities, relative risks), by making probabilistic one category at a time while keeping the others deterministic, and under all scenarios the findings showed great uncertainty, with a 95% CI cost saving – dominated”.

In the first year of implementation of extra operating lists, the mean costs for investment in extra operating lists early surgery were £47.4, and for the non-investment strategy £46.4.

For the second year, the mean costs associated with the strategy of investment for early surgery were £47.3, and for the non-investment strategy £46.4.

In the first year of implementation of extra operating lists, the mean effectiveness for the strategy of investment for early surgery was 2.3637, and for the non-investment strategy 2.3212. In the second year, they corresponded to 2.415 and 2.321 respectively.

95% CI of ICERs calculated from the 10,000 Monte Carlo simulations. The high uncertainty of the model is due to all the types of variables, including the effectiveness of interventions. We have tested the uncertainty of all categories of inputs in the model (costs, utilities, relative risks), by making probabilistic one category at a time while keeping the others deterministic, and under all scenarios the findings showed great uncertainty, with a 95% CI cost saving – dominated”.

From: 6, Timing of surgery

Cover of The Management of Hip Fracture in Adults
The Management of Hip Fracture in Adults [Internet].
NICE Clinical Guidelines, No. 124.
National Clinical Guideline Centre (UK).
Copyright © 2011, National Clinical Guideline Centre.

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