The cost-effectiveness of venous-converted acid-base and blood gas status in pulmonary medical departments

Figures & data

Figure 1 Markov model of admission to pulmonary department.

Table 1 Model input for cost-effect and department assumptions

Costs
Variable	EV	±SD	Ref.
Initial costs for venous conversion method
Education of nurses in venous conversion method (£)	770	400	Expert opinion
Product license to blood gas analyzer (£)	4,600	1500	Expert opinion
Incremental costs
Time use for arterial punctures (seconds)
– Doctor	360 + 134	15	Expert opinion
– Nurse	60 + 134	15	+3
– Biomedical laboratory technicians	120 + 134	15
Time use for venous-converted tests (seconds)			Expert opinion
– Nurse	60 + 134	15	+3
Annual cost of personnel (£)
– Doctors	69,150	21,380	HD
– Nurses	41,520	5,810	HD
– Laboratory technicians	42,880	4,790	HD
Complications per arterial puncture (£)	0.16	0.05	^Citation2,Citation16^–^Citation18
Materials for arterial punctures (£)	0.85	0.08	HD
Materials for venous-converted tests (£)	0.56	0.04	HD
Probability for extra use of materials
– Arterial punctures	0.1	0.025	^Citation2,Citation3,Citation18
– Venous punctures	0.05	0.01	^Citation3
Outcome assumptions
Effect of a venous-converted test (QALY)	0.00000035	0.00000018	3,21 + expert
Effect of an arterial puncture (QALY)	0	0	opinion
Assumptions for midsized department
Arterial punctures performed*	1958	100	HD
Blood gas analysis ordered	1789	100	Expert opinion
Number of patients per year	426	50	HD
Assumptions for small department
Arterial punctures performed*	818	50	Expert opinion
Blood gas analysis ordered	748	50	Expert opinion
Number of patients per year	178	25	Expert opinion

Note:

* Includes tests redone.

Abbreviations: EV, expected value; SD, standard deviation; Ref, reference; HD, hospital database; QALY, quality-adjusted life year.

Table 2 Main results of probabilistic sensitivity analysis

Monte Carlo simulation results for:	Midsized department	Small department
Incremental cost per admission:	−£3.10 (SD ± 1.54)	£0.01 (SD ± 2.40)
Incremental effect per admission:	0.0000012 QALY (SD ± 0.0000006)	0.0000012 QALY (SD ± 0.0000006)
ICER	Dominant	£10,645
Percentage cost-effective at a WTP of £30,000 per QALY gained	>95%	51%

Abbreviations: SD, standard deviation; ICER incremental cost-effectiveness ratio; WTP, willingness-to-pay; QALY, quality adjusted life year.

Figure 2 Incremental cost-effectiveness ratio scatterplots for midsized and small departments.

Figure 3 Cost-effectiveness acceptability curves for a small pulmonary department.

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