title: An economic evaluation of transdermal glyceryl trinitrate in the prevention of intravenous infusion failure.
abstract: A common cause of peripheral intravenous infusion failure is due to the patient developing phlebitis or extravasation. Recent clinical trials indicate that the use of transdermal glyceryl trinitrate (GTN patches) can reduce the incidence of infusion failure and hence the costs of re-infusion. In this study we conduct an economic evaluation of this new pharmaceutical application to determine whether the use of such patches results in hospital resource cost savings. Time-to-first infusion failure probabilities from a placebo-controlled trial are used to model the sequential failure problem as a Markov process. Using estimated staff and materials costs for first and subsequent infusions, we calculate the expected cost per infused patient to time t for treatment and control groups. Using this simple comparative cost method, results indicate that the net impact on hospital resources from patch usage is dependent upon the total required length of infusion time. Analysis of infusion time thresholds indicates that for patients requiring long-term (t greater than 50 hours) periods of infusion the use of patches is likely to generate resource savings. We conclude that to realize such resource savings clinical decisions to infuse with GTN patches should incorporate the prior probability that the total required length of infusion time exceeds 50 hours.
authors.affiliation: Health Economics Research Group, Brunel University, Uxbridge, Middlesex, U.K.
authors.forename: B J
authors.initials: BJ
authors.lastname: O'Brien
authors.forename: M J
authors.initials: MJ
authors.lastname: Buxton
authors.forename: H T
authors.initials: HT
authors.lastname: Khawaja
mesh_terms: D000279:Administration, Cutaneous; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000517:prevention & control*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D008390:Markov Chains; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D010689:Phlebitis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D005996:Nitroglycerin