Unit costs

National Guideline Centre (UK)

Appendix OUnit costs

Publication Details

O.1. Risk factors and risk assessment tools

None.

O.2. Diagnostic tests

See Table 63 in Appendix N.

O.3. Severity risk tools

Table 91. Unit costs of severity risk tools.

O.4. Surveillance for the early detection of hepatocellular carcinoma (HCC)

See Table 64 in Appendix N.

O.5. Surveillance for the detection of varices

See Table 64 in Appendix N.

O.6. Prophylaxis of variceal haemorrhage

Table 92

Unit costs of variceal haemorrhage prophylaxis – band ligation.

Table 93

Unit costs of variceal haemorrhage prophylaxis – beta blockers.

O.7. Primary prevention of bacterial infections in cirrhosis and gastrointestinal bleeding

Table 94

Unit costs of antibiotics to treat bacterial infections.

O.8. Transjugular intrahepatic portosystemic shunt (TIPS) versus large-volume paracentesis (LVP) for ascites

Table 95. Unit costs of TIPS and LVP procedures.

O.9. Primary prevention of spontaneous bacterial peritonitis (SBP) in people with cirrhosis and ascites

Table 96

Unit costs of antibiotics used for the primary prevention of SBP.

Table 97

Unit costs of managing SBP related complications.

O.10. Volume replacers in hepatorenal syndrome

Table 98. Unit costs of IV volume replacers.

O.11. Management of an episode of acute hepatic encephalopathy

Table 99

Unit costs of drugs used to manage acute hepatic encephalopathy.

Publication Details

Copyright

Publisher

National Institute for Health and Care Excellence (NICE), London

NLM Citation

National Guideline Centre (UK). Cirrhosis in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (NICE); 2016 Jul. (NICE Guideline, No. 50.) Appendix O, Unit costs.

Table 91Unit costs of severity risk tools

Risk tool	Unit cost	Comments
Child-Pugh	£7.42^(a)	Includes bilirubin, albumin, INR, ascites events, hepatic encephalopathy events
MELD	£10.42^(a)	Includes creatinine, bilirubin, INR
Transient elastography	£68.00	Imaging technique

: Sources: Donnan 2009, NHS hospital trust (GDG source)

a: MELD and Child-Pugh are inflated to 2013–14 prices

Table 92Unit costs of variceal haemorrhage prophylaxis – band ligation

Treatment	Unit cost	Details
Band ligation	£1,326	£530 per procedure; assuming 2.5 procedures

: Source: NHS Hospital trust; GDG assumption

Table 93Unit costs of variceal haemorrhage prophylaxis – beta blockers

Treatment	Daily dose	Cost per day	Cost per year
Propranolol^(a)	60–120 mg	£0.08–0.16	£28.37–56.74
Carvedilol^(b)	6.25–12.5 mg	£0.05, £0.04	£17.86, £16.42

: Sources: NHS Drug Tariff July 2015

a: Starting dose 20 mg three times per day, adjusted up to 40 mg three times per day, according to drug response

b: Starting dose 6.25 mg, adjusted up to 12.5 mg according to drug response; note that 12.5 mg tablets are cheaper than 6.25 mg tablets

Table 94Unit costs of antibiotics to treat bacterial infections

Antibiotic	Daily dose	Cost per day	Cost of 5-day course
Ceftriaxone (IV)	1 g	£9.58	£47.90
Ceftriaxone (IV)	2 g	£19.18	£95.90
Ciprofloxacin (oral)	500 mg ×2	£0.21	£1.05
Norfloxacin (oral)^(a)	400 mg ×2^(b)	£1.71	£8.57
Norfloxacin (oral)^(a) + ceftriaxone (IV)	400 mg ×2 + 2 g	£20.89	£104.47
Ofloxacin (oral)	400 mg ×2	£4.36	£21.8

: Sources: NHS Drug Tariff July 2015, BNF August 2014

a: Norfloxacin is currently unavailable in the UK

b: Note that the Spanish group study used 1x 400 mg dosage

Table 95Unit costs of TIPS and LVP procedures

Procedures	Unit cost	Details
TIPS	£2,904	Average procedure costs of 28 patients
LVP	£672	Cost per single procedure, includes 1 elective day case admission, 100 ml of 20% albumin, catheter system use

: Sources: TIPS: Parker 2013; LVP: NHS reference costs 2013–14, Parker 2013, GDG

Table 96Unit costs of antibiotics used for the primary prevention of SBP

Antibiotic	Daily dose	Cost per day	Cost per year
Ciprofloxacin (oral)	500 mg	£0.11	£40
Ciprofloxacin (oral)	750 mg	£0.80^(a)	£292^(a)
Norfloxacin (oral)^(b)	400 mg	£0.86	£313

: Sources: NHS Drug Tariff 2015, BNF August 2014

a: Or £0.11 per day (£40 per year) if one and a half 500 mg tablets are used instead

b: Norfloxacin is not currently available in the UK

Table 97Unit costs of managing SBP related complications

Cost type	Unit cost	Details
7 day hospital stay	£1,561	GB03D (excess days), Intermediate, Endoscopic or Percutaneous, Hepatobiliary or Pancreatic Procedures, with CC Score 5-7
Tazocin	£237.30	Piperacillin 4 g/tazobactam 500 mg IV every 8 hours for 5 days
Paracentecis	£78
Ultrasound	£49

: Sources: NHS reference costs 2013–14, NHS Drug Tariff July 2015, Parker 2013, GDG

Table 98Unit costs of IV volume replacers

IV fluid type	Unit cost for 100 ml bag	Unit cost for 250 ml bag	Unit cost for 500 ml bag	Unit cost for 1000 ml bag
IV albumin
Albumin (4.5%)	–	£17.03	–	–
Albumin (5%)	–	–	£30.52	–
Albumin (20%)	£35–50	–	–	–
IV crystalloids
Ringer's lactate solution	–	–	£1.25	–
0.9% sodium chloride (saline)	–	–	£0.63	£0.70
Hartmann's solution	–	–	£0.70	£0.85
Dextrose (5%)	–	–	£0.63	£0.70
IV polygels, plasma, colloids
Plasmalyte 148ph 7.4	–	–	–	£0.92
Haemocel	–	–	–	–
Gelofusion/gelofusine	–	–	–	£4.80
Dextran 70 (RescueFlow)	–	£28.50	–	–
Mannitol (10%)	–	–	£3.20	–
Mannitol (20%)	–	£3.78	£5.80	–
Voluven	–	–	£7.50–12.50	–
Volulyte	–	–	£7.65–18.00	–

: Sources: BNF July 2015, NICE CG174 Intravenous fluid therapy in adults in hospital, personal communication with NHS hospitals

Table 99Unit costs of drugs used to manage acute hepatic encephalopathy

Drug	Cost per day^(a)	Dosage
BCAA	–	No cost information
Flumazenil (IV)	£81.00	One 5 ml ampule, 6x per day
Lactulose (oral solution)	£0.32	10–30 ml, 2–3x per day (average 50 ml)
Lactitol	Not prescribable
LOLA	£34.4	10 ml ampoules, 4× per day
Metronidazole	£0.22	One 400 mg tablet, 3× per day
MARS	–	No cost information
Neomycin sulphate	£0.50	One 500 mg tablet, 2× per day
Rifaximin	£9.26	One 550 mg tablet, 2× per day

: Sources: NHS Drug Tariff July 2015, BNF July 2015, NHS hospital trust (GDG source)

a: Costs would apply for the duration of acute care (up to 5 days)