Gastroenterologist and nurse management of symptoms after pelvic radiotherapy for cancer: an economic evaluation of a clinical randomized controlled trial (the ORBIT study)

Figures & data

Table 1 Resources and costs (British pounds 2013)

Treatment group	N	Baseline consultation duration			Additional consultationsa			Investigations, treatments		Medications		Total cost
		Mean (min)	SD (min)	Costb (£)	Mean, n	SD	Costb (£)	Mean costc (£)	SD	Mean costd (£)	SD	Mean (£)	SD
Based on participants with SF-12 (QALY) data at baseline and 6 months
Nurse	61	47.5	21.5	70	1.03	0.86	22.66	786	493	17	23.77	895	499
Consultant	51	29.7	15.8	162	0.98	0.95	80.12	793	527	66	152.46	1101	567
Based on participants with IBDQ-B data at baseline and 6 months
Nurse	66	47.8	20.9	70.	1.03	0.86	22.66	768	494	17	23.25	878	498
Consultant	59	29.4	14.9	159	1	1	82.60	764	536	69	166.7	1075	580

Notes:

a Duration based on 15-minute consultation.

b Unit costs for specialist nurse is £88/hour²³ and for gastroenterologist is £162/consultation of 30 minutes.²²

c Costs of investigations and treatments supplied by the hospital finance department: abdominal X-ray £49.95; anal ultrasound £77.23; bloods battery £75.12; colonoscopy £683.00; CT scan £120.34; flexible sigmoidoscopy £436.95; breath test £142.28; MRI scan £288.97; SehCAT scan £265.00; stool culture £28.13; endoscopy £491.56; fecal elastase £15.76; liver ultrasound £77.23.

d Total cost of medications per patient supplied by clinical team.

Abbreviations: CT, computerised tomography; IBDQ-B, Inflammatory Bowel Disease Questionnaire; MRI, magnetic resonance imaging; QALY, quality-adjusted life year; SehCAT scan, selenium homocholic acid taurine scan; SD, standard deviation; SF-12, Medical Outcomes Study’s Short-Form 12.

Table 2 Outcomes

Treatment group	N	Utility score (baseline)		Utility score (6 months)		Incremental QALYs gained versus booklet groupa
		Utility	SD	Utility	SD	Mean	SD
Based on participants with SF-12 (QALY) data at baseline and 6 months
Booklet	47	0.776	0.200	0.797	0.170
Nurse	61	0.789	0.172	0.792	0.177	−0.0036	0.005
Consultant	51	0.799	0.165	0.829	0.157	0.0044	0.005
Consultant vs. nurse	51					0.0076	0.006
	N	IBDQ-B score (baseline)		IBDQ-B score (6 months)		Incremental change in IBDQ-B score vs. booklet groupa
Based on participants with IBDQ-B data at baseline and 6 months
Booklet	57	52.53	12.66	57.46	12.86
Nurse	66	52.95	10.13	62.00	10.21	4.12b	2.0 (SE)
Consultant	59	52.62	10.93	60.68	10.76	5.07b	2.16 (SE)
Consultant vs. nurse						0.95	1.68 (SE)

Notes:

a Incremental QALY gain based on ordinary least squares regression estimates controlling for baseline utility.

b Differences between groups statistically significant at a 5% level using two-sample t-test. Within-group changes were significant for nurse and consultant, but not for booklet.⁵

Abbreviations: IBDQ-B, Inflammatory Bowel Disease Questionnaire; SD, standard deviation; QALY, quality-adjusted life year; SE, standard error; SF-12, Medical Outcomes Study’s Short-Form 12.

Figure 1 QALY scores: cost-effectiveness planes and cost-effectiveness acceptability frontier.

Abbreviation: QALY, quality-adjusted life years.

Table 3 Cost-utility and cost-effectiveness analysis

Cost-utility analysis	N	Incremental cost (£)	Incremental mean change in QALY	ICER (incremental cost per QALY gained)
Nurse vs. booklet	108	£895	−0.0036	Dominated
Consultant vs. booklet	98	£1102	0.0044	£250,455
Consultant vs. nurse	112	£207	0.0076	£25,875
Cost effectiveness analysis	N	Incremental cost (£)	Incremental mean change in IBDQ-B score	ICER (incremental cost per 6-point IBDQ-B score gain)
Nurse vs. booklet	123	£878	4.12	£1279
Consultant vs. booklet	116	£1076	5.07	£1273
Consultant vs. nurse	125	£198	0.95	£1251

Abbreviations: IBDQ-B, Inflammatory Bowel Disease Questionnaire; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year.

Figure 2 IBDQ-B scores: cost-effectiveness planes and cost-effectiveness acceptability frontier.

Abbreviation: IBDQ-B, inflammatory bowel disease questionnaire.

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