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National Clinical Guideline Centre (UK). Delirium: Diagnosis, Prevention and Management [Internet]. London: Royal College of Physicians (UK); 2010 Jul. (NICE Clinical Guidelines, No. 103.)

Appendix JHealth economics appendix

Summary of included studies

Two studies aimed at the prevention of delirium in a hospital care setting, one aimed at treatment in hospital setting, and one aimed at prevention in long term care. Two studies were multi-component interventions (Rizzo 2001, Pitkala 2008), one was single component, non-pharmacological intervention (Robinson 2002), and one was a pharmacological intervention (Bracco 2007). There was one randomised controlled trial (Pitkala 2008), two non-randomised controlled trials (Rizzo 2001, Bracco 2007) and one before and after study (Robinson 2002). Multivariate analysis was done in two studies (Rizzo 2001, Bracco 2007). Two studies were carried out in the USA, one in Australia, one in Finland and one in Canada. None of the studies took a UK NHS and personal social services perspective and none measured health benefits in QALYs. All of the studies reported costs and outcomes separately. None of the studies discounted future costs and outcomes appropriately and none carried out a robust sensitivity analysis on the results of an economic analysis. As we found no published economic evaluations that were directly applicable, it was decided that an original economic evaluation should be developed to determine the cost effectiveness of the interventions considered in this guideline.

Table J1. Characteristics of included studies

Table J2. Assessment of the applicability of included studies

Table J3. Excluded studies and reasons for exclusion

Reference List for health economic studies

  • Beaupre LA, et al. Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway. Quality and Safety in Health Care. 2006;15.5:375–79. [PMC free article: PMC2565826] [PubMed: 17074877]
  • Bracco D, et al. Epidural anaesthesia improves outcome and resource use in cardiac surgery: A single-center study of a 1293-patient cohort. Heart Surgery Forum. 2007;10.6:301–10. [PubMed: 18187377]
  • Caplan GA, et al. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial) (DARE provisional record). Age and Ageing. 2006;35:53–60. [PubMed: 16239239]
  • Caplan GA, Harper EL. Recruitment of volunteers to improve vitality in the elderly: the REVIVE study (DARE provisional record). Internal Medicine Journal. 2007;37:95–100. [PubMed: 17229251]
  • Heyman EN, Lombardo BA. Managing costs: the confused, agitated, or suicidal patient. Nursing Economics. 13.2(118):107–11. [PubMed: 7760955]
  • Pandharipande PP, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298.22:2644–53. [PubMed: 18073360]
  • Pitkala KH, et al. Multicomponent geriatric intervention for elderly inpatients with delirium: effects on costs and health-related quality of life. Journals of Gerontology Series A-Biological Sciences and Medical Sciences. 2008;63.1:56–61. [PubMed: 18245761]
  • Rizzo JA, et al. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value (DARE structured abstract). Medical Care. 2001;39:740–52. [PubMed: 11458138]
  • Robinson SB, Rosher RB. Can a beverage cart help improve hydration? Geriatric Nursing. 2002;23.4:208–11. [PubMed: 12183746]
  • Rubin FH, et al. Replicating the hospital elder life program in a community hospital and demonstrating effectiveness using quality improvement methodology (DARE structured abstract). Journal of the American Geriatrics Society. 2006;54:969–74. [PubMed: 16776794]
  • Webster JR, et al. Improving clinical and cost outcomes in delirium: Use of practice guidelines and a delirium care team. Annals of Long-Term Care. 1999;7.4:128–34.
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Cover of Delirium
Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
National Clinical Guideline Centre (UK).

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