Costs and quality of life associated with acute upper gastrointestinal bleeding in the UK: cohort analysis of patients in a cluster randomised trial.
OBJECTIVE
Data on costs associated with acute upper gastrointestinal bleeding (AUGIB) are scarce. We provide estimates of UK healthcare costs, indirect costs and health-related quality of life (HRQoL) for patients presenting to hospital with AUGIB.


METHODS
Six UK university hospitals with >20 AUGIB admissions per month, >400 adult beds, 24 h endoscopy, and on-site access to intensive care and surgery.


METHODS
936 patients aged ≥18 years, admitted with AUGIB, and enrolled between August 2012 and March 2013 in the TRIGGER trial of AUGIB comparing restrictive versus liberal red blood cell (RBC) transfusion thresholds.


METHODS
Healthcare resource use during hospitalisation and postdischarge up to 28  days, unpaid informal care, time away from paid employment and HRQoL using the EuroQol EQ-5D at 28  days were measured prospectively. National unit costs were used to value resource use. Initial in-hospital treatment costs were upscaled to a UK level.


RESULTS
Mean initial in-hospital costs were £2458 (SE=£216) per patient. Inpatient bed days, endoscopy and RBC transfusions were key cost drivers. Postdischarge healthcare costs were £391 (£44) per patient. One-third of patients received unpaid informal care and the quarter in paid employment required time away from work. Mean HRQoL for survivors was 0.74. Annual initial inhospital treatment cost for all AUGIB cases in the UK was estimated to be £155.5 million, with exploratory analyses of the incremental costs of treating hospitalised patients developing AUGIB generating figures of between £143 million and £168 million.


CONCLUSIONS
AUGIB is a large burden for UK hospitals with inpatient stay, endoscopy and RBC transfusions as the main cost drivers. It is anticipated that this work will enable quantification of the impact of cost reduction strategies in AUGIB and will inform economic analyses of novel or existing interventions for AUGIB.


BACKGROUND
ISRCTN85757829 and NCT02105532.
Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
H E
HE
Campbell
Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
E A
EA
Stokes
Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK.
D
D
Bargo
Nottingham Digestive Diseases NIHR Biomedical Research Unit, University of Nottingham, Nottingham, UK.
R F
RF
Logan
Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK.
A
A
Mora
Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK.
R
R
Hodge
Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
A
A
Gray
Nottingham Digestive Diseases NIHR Biomedical Research Unit, University of Nottingham, Nottingham, UK.
M W
MW
James
Gastrointestinal Unit, Glasgow Royal Infirmary, Glasgow, UK.
A J
AJ
Stanley
Department of Gastroenterology, St James's University Hospital, Leeds, UK.
S M
SM
Everett
Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
A A
AA
Bailey
Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK.
H
H
Dallal
Department of Gastroenterology, James Cook University Hospital, Middlesbrough, UK.
J
J
Greenaway
Clinical Trials Unit, NHS Blood and Transplant, Oxford, UK.
C
C
Dyer
Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK.
C
C
Llewelyn
Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
T S
TS
Walsh
Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
S P L
SP
Travis
Clinical Trials Unit, NHS Blood and Transplant, Oxford, UK National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and University of Oxford, Oxford, UK.
M F
MF
Murphy
Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK Clinical Trials Unit, NHS Blood and Transplant, Oxford, UK.
V
V
Jairath
D000208:Acute Disease; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics* / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000706:statistics & numerical data; D006471:Gastrointestinal Hemorrhage / Q000191:economics* / Q000453:epidemiology / Q000523:psychology; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D006113:United Kingdom / Q000453:epidemiology
HEALTH ECONOMICS