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Supporting Evidence 2 PDF 3.33 MB National Institute for Health and Care Excellence Draft for consultation Intrapartum care for women with existing medical conditions or obstetric complications and their babies Supplement 2: Health economics NICE guideline <TBC at publication> Health economics September 2018 Draft for consultation Developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists DRAFT FOR CONSULTATIONCONSULTATION Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2018. All rights reserved. Subject to Notice of Rights ISBN: DRAFT FOR CONSULTATION DRAFT FOR CONSULTATION Contents Contents Health economics.......................................................................................................... 8 Economic evidence literature reviews ......................................................................... 9 Women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions ........................................................... 9 Women at high risk of adverse outcomes for themselves and/or their baby because of obstetric complications or other reasons ...................................................... 9 Modelling cost effectiveness of antenatal care planning involving a multidisciplinary team for women with existing medical conditions ................ 11 Introduction ............................................................................................................ 11 Methods ................................................................................................................. 12 Model structure.............................................................................................. 12 Setting and population ................................................................................... 13 Clinical outcomes .......................................................................................... 13 Treatment effectiveness ......................................................................................... 14 Quality adjusted life years ............................................................................. 14 Costs and resource use ................................................................................. 15 Tornado diagram inputs ................................................................................. 17 Results ................................................................................................................... 18 Probabilistic sensitivity analysis ..................................................................... 18 Deterministic analysis .................................................................................... 21 Discussion .............................................................................................................. 24 Conclusion ............................................................................................................. 25 Modelling cost effectiveness of ultrasound needle siting of central neuraxial blockade for women with obesity ....................................................................... 26 Introduction ............................................................................................................ 26 Methods ................................................................................................................. 26 Model structure.............................................................................................. 26 Setting and population ................................................................................... 27 Clinical outcomes and baseline risk ............................................................... 27 Treatment effectiveness ................................................................................ 28 Quality adjusted life years ............................................................................. 28 Costs and resource use ................................................................................. 30 Tornado diagram inputs ................................................................................. 31 Results ................................................................................................................... 32 Base-case inputs ........................................................................................... 32 Analysis taking into account puncture attempts ............................................. 35 Analysis taking into account the duration of the procedure ............................ 36 Scenario analysis increasing the effectiveness of ultrasound ........................ 37 5 DRAFT FOR CONSULTATION Contents Discussion .............................................................................................................. 39 Conclusion ............................................................................................................. 40 Modelling cost effectiveness of mode of birth for women with a large-for- gestational-age baby ............................................................................................ 41 Introduction ............................................................................................................ 41 Methods ................................................................................................................. 41 Model structure.............................................................................................. 41 Setting and population ................................................................................... 43 Clinical outcomes .......................................................................................... 43 Baseline 43 Treatment effectiveness ................................................................................ 44 Costs 46 Quality adjusted life years ............................................................................. 47 Uncertainty .................................................................................................... 48 Tornado diagram inputs ................................................................................. 48 Results ................................................................................................................... 49 Base case ..................................................................................................... 49 Sensitivity analysis excluding anal and urinary incontinence from the model . 55 Sensitivity analysis restricting model outcomes to brachial plexus injuries and intracranial haemorrhage ................................................................... 57 Discussion .............................................................................................................. 59 Conclusion ............................................................................................................. 61 References ................................................................................................................... 62 Appendices .................................................................................................................. 66 Appendix A – Literature search strategies .............................................................. 66 Health economics global search for women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions ........................................................................................... 66 Health economics global search for women at high risk of adverse outcomes for themselves and/or their baby because of obstetric complications or other reasons ..................................................................................... 91 Health economics search for intrapartum care for women with sepsis – antimicrobial therapy ........................................................................ 107 Appendix B – Economic evidence study selection ................................................ 128 Health economics global search for women at high risk
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