Table J1Characteristics of included studies

Primary detailsDesignPatient characteristicsInterventionsOutcome measuresResultsComments
Author (Year): Pitkala 2008

Country: Finland (government funded health care)

Funding: Lions Organization, Helsinki University Central Hospital, Helsinki City, the Academy of Finland

Type of analysis: Cost-effectiveness
Study design: RCT

Time horizon:
1 year

Discounting:
None

Perspective: Finnish, Helsinki city hospital, resources valued at average unit costs

Cost year: 2001
Consecutive delirium patients above 68 years admitted to the general medicine services. Life expectancy was predicted to be above 6 months.Intervention: Comprehensive geriatric assessment at baseline, atypical antipsychotics were used if necessary, effective general treatments; after acute phase of delirium, patients not recovering from impaired cognition underwent detailed diagnostics of dementia and thereafter received acetyl cholinesterase inhibitors.

Comparator: Received usual care. What constituted usual care was not exactly described
  1. Mortality rate
  2. Cost (per patient) incurred in the intervention and usual care arms
  1. I:35%, C:30%, n=87, p=0.52
  2. Patient’s reported HRQoL, I:0.68 (SD 0.12), C:0.62 (SD 0.15); p=0.02
Intervention improved mental function, usual activities, vitality, depression and speech
3.

I: €19,737; C: €19,557 (this were based on the use and unit cost of the following health services: primary hospitals, specialized hospitals, specialist consultations, psychiatrist hospitals, nursing homes, long-term care hospitals, skilled home nursing)

Mortality rate was not an adjusted estimate, and health status was measured with an ordinal scale
Author (Year):Rizzo (2001)

Country: USA

Funding:
National Institute on Aging, in-kind support from the Claude D. Pepper Older Americans Independence Centre. One of the authors was a recipient of a Midcareer Award from the National Institute on aging and a Donaghue Investigator Award from the Patrick and Cathering Weldon Donaghue Medical research Foundation

Type of analysis: Cost-effectiveness
Study design: Non-randomised intervention study

Time horizon: Unclear. Study participants enrollment period was 3 years

Discounting:
None

Perspective: Hospital health care provider

Cost year: 1995
70 year old patients (and those older than 70 years) with no evidence of delirium but who had intermediate or high risk of deliriumIntervention: multi-component intervention (Hospital Elderly Life Program)

Comparator: Usual hospital care
  1. Mortality rate
  2. Additional Cost (per patient) of intervention
  3. Non-intervention costs
  4. Overall net cost
  1. Intermediate risk patients: I:6.5%, C:11.7%, p<0.5; High risk patients: I:18.5%, C:23.5%, NS; Overall:I:9.9%, C:15.0%, p<0.5
  2. I:1%, C:2%
  3. Intermediate risk patients: I:$564(SE 25), C:$0; High risk patients: I:$662(SE 38), C:$0; Overall:I:$592(SE 21), C:$0
  4. Intermediate risk patients: I:$6,124(SE337), C:$7,565(SE$545); High risk patients: I:$7,414(SE$665), C:$6,618(SE $468); Overall:I:$6,484(SE 307), C:$7,300(SE $414)
  5. Overall:I:$7,076, C:$7,300
Study was in a single hospital only and was not a randomised trial.
Author (Year): Bracco (2007)

Country: Canada

Funding: Not stated

Type of analysis: Cost-effectiveness
Study design: Non-randomized clinical trial

Time horizon: Not clear

Discounting: None

Perspective: Not clear

Cost year: Not clear
Patients who underwent cardiac surgeryIntervention: Use of thoracic epidural anaesthesia for cardiac surgery. Patients received 5ml test dose of 1.5% lidocaine with 1:200,000 epinephrine which was given through an epidural catheter. The block was loaded with 6 to 8 ml of 0.125% or 0.25% bupivacaine. Anaesthesia was induced with propofol (1–2mg/kg), fentanyl (2–4 μg/kg), or sufentanil (0.2– 0.5μg/kg) and rocuronium (0.6mg/kg)

Comparator: No use of thoracic epidural anaesthesia for cardiac surgery. Anaesthesia was maintained with intravenous opioids (up to 10–15 μg/kg of fentanyl), benzodiazepines (5–10mg midazolam), and sevoflurane (1–1.5 MAC)
  1. Mortality rate
  2. Additional Cost (per patient) of intervention
  1. Post-operative delirium complication rate. I:4/506, C:20/787, p<0.02, RR:0.31(95%CI 0.11 to 0.90)
  2. ICU Mortality. I: 2/506, C: 14/787, p<0.04, RR: 0.22(95%CI 0.05 to 0.97). Low overall mortality incidence
  3. $82
Large sample size, however, cost estimates were not based on clearly described resource use, no sensitivity analysis
Author (Year): Robinson (2002)

Country: USA

Funding: The Retirement Research Foundation

Type of analysis: Cost-effectiveness
Study design: before-and-after non-randomised study

Time horizon: Intervention occurred within 5 weeks. Data collection occurred 2 weeks before and after intervention

Discounting: None

Perspective: Not clear. Intervention materials were purchased from retail shop

Cost year: Not clear
Older adult patients in a nursing homeIntervention: Hydration program (to improve dehydration) which included a hydration assistant, an individualized plan of care incorporating the most effective techniques to administer fluid, a colourful beverage cart with colourful pitchers and glasses to enhance residents’ interest in drinking, and a choice from 4 beverages at each encounter. Goal was for each resident to consume an additional 8-ounce beverage mid-morning and mid-afternoon, which would increase fluid intake to 1.5L daily

Comparator: Use of usual gray coloured institutional carts, white foam cups and limited variety of beverages
  1. Additional Cost of intervention
  2. Cost savings due to the prevention of associated negative outcomes by intervention
  1. Cost of colourful cups and assorted beverages was $3 per resident per week and average cost of employee time per resident per week was $8
  2. $103 (p=0.05) per resident per week
There was no measure of delirium incidence or severity, mortality or HRQoL

From: Appendix J, Health economics appendix

Cover of Delirium
Delirium: Diagnosis, Prevention and Management [Internet].
NICE Clinical Guidelines, No. 103.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre - Acute and Chronic Conditions.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright Designs and Patents Act, 1988.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.