title: Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients.
  
  
  METHODS
  A cost-effectiveness analysis using data from a randomised controlled trial (RCT). In the RCT 138 patients undergoing major elective surgery were allocated to receive pre-operative optimisation employing either adrenaline or dopexamine (assigned randomly), or to receive routine peri-operative care. Differential health service costs were based on trial data on the number and cause of hospital in-patient days and the utilisation of health care resources. These were costed using unit costs from a UK hospital. The cost-effectiveness analysis related differential costs to differential life-years during a 2 year trial follow-up.
  
  
  RESULTS
  The mean number of in-patient days was 16 in the pre-optimised groups (19 adrenaline; 13 dopexamine) and 22 in the standard care group. The number (%) of deaths, over a 2 year follow-up, was 24 (26%) in the pre-optimised groups and 15 (33%) in the standard care group. The mean total costs were EUR 11,310 in the pre-optimised groups and EUR 16,965 in the standard care group. Life-years were 1.68 in the pre-optimised groups and 1.46 in the standard care group. The probability that pre-operative optimisation is less costly than standard care is 98%. The probability that it dominates standard care is 93%.
  
  
  CONCLUSIONS
  Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment.
authors.affiliation: Centre for Health Economics, IRISS, University of York, Heslington, York, YO10 5DD, UK. ealf100@york.ac.uk
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fenwick
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Sculpher
authors.forename: Karl
authors.initials: K
authors.lastname: Claxton
mesh_terms: D001499:Bayes Theorem; D003362:Cost-Benefit Analysis; D004298:Dopamine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004837:Epinephrine / Q000627:therapeutic use*; D006302:Health Services Research; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010100:Oxygen / Q000008:administration & dosage*; D011300:Preoperative Care / Q000191:economics* / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; C046318:dopexamine; D010100:Oxygen; D004298:Dopamine; D004837:Epinephrine