Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR).
BACKGROUND
Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system.


METHODS
The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated.


CONCLUSIONS
In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain.


BACKGROUND
The CESAR trial registration number is ISRCTN47279827.
Thalanany
Mariamma M
MM
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK. m.mugford@uea.ac.uk.
Mugford
Miranda
M
Hibbert
Clare
C
Cooper
Nicola J
NJ
Truesdale
Ann
A
Robinson
Steven
S
Tiruvoipati
Ravindranath
R
Elbourne
Diana R
DR
Peek
Giles J
GJ
Clemens
Felicity
F
Hardy
Polly
P
Wilson
Andrew
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003625:Data Collection / Q000379:methods; D004185:Disability Evaluation; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012121:Respiration, Artificial / Q000191:economics*; D012128:Respiratory Distress Syndrome / Q000191:economics / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D016019:Survival Analysis; D013673:Technology Assessment, Biomedical; D006113:United Kingdom