Unit cost of services

Gill Livingston; Julie Barber; Penny Rapaport; Martin Knapp; Mark Griffin; Renee Romeo; Derek King; Debbie Livingston; Elanor Lewis-Holmes; Cath Mummery; Zuzana Walker; Juanita Hoe; Claudia Cooper

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Livingston G, Barber J, Rapaport P, et al. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Technology Assessment, No. 18.61.)

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START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia.

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Appendix 1Unit cost of services

TABLE 17

Unit costs of services

Service	Unit cost (£) 2009–10^a	Source
Anticoagulant service (per attendance)	18	Department of Health (2010)⁴⁹
Physiotherapy (per attendance)	38	Department of Health (2010)⁴⁹
Podiatry (per attendance)	43	Department of Health (2010)⁴⁹
Electrocardiography (per attendance)	45	Department of Health (2010)⁴⁹
Ophthalmology (per attendance)	73	Department of Health (2010)⁴⁹
Ear nose and throat (per attendance)	85	Department of Health (2010)⁴⁹
Other adult outpatient services (per attendance)	90	Department of Health (2010)⁴⁹
Dermatology (per attendance)	93	Department of Health (2010)⁴⁹
Diagnostic imaging – CT scan (brain) (per attendance)	95	Department of Health (2010)⁴⁹
Orthopaedics (per attendance)	99	Department of Health (2010)⁴⁹
Urology (per attendance)	102	Department of Health (2010)⁴⁹
Accident and emergency not-leading-to-admitted (per attendance)	106	Department of Health (2010)⁴⁹
Endocrinology (per attendance)	110	Department of Health (2010)⁴⁹
General surgery (per attendance)	112	Department of Health (2010)⁴⁹
Gynaecology (per attendance)	118	Department of Health (2010)⁴⁹
Clinical oncology (per attendance)	126	Department of Health (2010)⁴⁹
Medical gastroenterology (per attendance)	128	Department of Health (2010)⁴⁹
Diabetic medicine (per attendance)	130	Department of Health (2010)⁴⁹
Cardiology (per attendance)	134	Department of Health (2010)⁴⁹
Rheumatology (per attendance)	138	Department of Health (2010)⁴⁹
Respiratory medicine (per attendance)	148	Department of Health (2010)⁴⁹
Haematology (per attendance)	152	Department of Health (2010)⁴⁹
Nephrology (per attendance)	156	Department of Health (2010)⁴⁹
Neurology (per attendance)	168	Department of Health (2010)⁴⁹
Diagnostic imaging – MRI (per attendance)	175	Department of Health (2010)⁴⁹
Acute adult inpatient care (per bed-day)	295	Curtis (2010)⁵⁰
Elderly rehabilitation services (per bed-day)	296	Curtis (2010)⁵⁰
Admiral Nurse (per hour)	31	Curtis (2010)⁵⁰
Chiropodist (per hour)	22	Curtis (2010)⁵⁰
Counsellor (per hour)	34	Curtis (2010)⁵⁰
Dentist (per attendance)^b	87	Curtis (2010)⁵⁰
GP (per consultation)	28	Curtis (2010)⁵⁰
NHS direct (per hour)	3	Curtis (2010)⁵⁰
Optician (per hour)	29	Curtis (2010)⁵⁰
Outreach worker (per hour)	15	Curtis (2010)⁵⁰
Home care worker/care attendant (per weekday hour)	21	Curtis (2010)⁵⁰
Physiotherapist (per hour)	22	Curtis (2010)⁵⁰
Psychotherapist (per hour)	39	Curtis (2010)⁵⁰
Hygienist (per hour)	174	Department of Health (2010)⁴⁹
Company medical check-up (per session)^c	175	Marie Stopes International; www.mariestopes.org.uk/Womens_services/Well_Woman_screening/Company_health_screening.aspx
Nurse (advanced) (per hour)	37	Curtis (2010)⁵⁰
Occupational therapist (per hour)	39	Curtis (2010)⁵⁰
Community psychiatrist (per hour)	22	Curtis (2010)⁵⁰
Practice nurse (per hour)	26	Curtis (2010)⁵⁰
District nurse (per hour)	31	Curtis (2010)⁵⁰
Social worker (per hour)	40	Curtis (2010)⁵⁰
Speech and language therapist (per hour)	22	Curtis (2010)⁵⁰
Ambulance transport (per journey)^d	40–246	Curtis (2010)⁵⁰
Dietician (per hour)	22	Curtis (2010)⁵⁰
Clinical support worker nursing (per hour)	15	Curtis (2010)⁵⁰
Support group (per hour)	9	Curtis (2010)⁵⁰
Community nurse (per hour)	31	Curtis (2010)⁵⁰
Orthodontist (per hour)	174	Curtis (2010)⁵⁰
Day care: NHS provision (per day)	66	Curtis (2010)⁵⁰
Day care: local authority provision (per day)	43	Curtis (2010)⁵⁰
Day care: voluntary provision (per day)	42	Curtis (2010)⁵⁰
Alzheimer’s café (per hour)^e	6	Curtis (2010)⁵⁰
Dementia course (per hour)^f	17	Dementia UK; http://dementiauk.org/what-we-do/learning-partnerships-and-training/opencources-2011/courses-by-huest-trainers
Alternative complementary therapies (per hour)	40	Professor Jennifer Beecham, PSSRU, London School of Economics and Political Science, 2012, personal communication
Yoga and pilates (per hour)	7	www.thetotalcareclinic.co.uk/yoga-pilates-classes-southampton.htm

: CT, computerised tomography; MRI, magnetic resonance imaging.
a: 2008–9 prices uprated to 2009–10 prices using the Hospital and Community Health Services Pay and Prices Index.
b: Attendance assumed to last 30 minutes.
c: Session is 30 minutes in duration.
d: £40 for transport to hospital; £246 for emergency transport.
e: Weighted average of day care provision by NHS, local authority and voluntary provision per day divided by 8 hours.
f: 1-day 6-hour course assumed.

Discounted treatment and cost effects and incremental cost-effectiveness ratios over 24 months

TABLE 18

Treatment and cost effects (with 95% CI) and ICERs

Outcome	Incremental differences and ICERs 24-month evaluation time point (discounted 0%)	Incremental differences and ICERs 24-month evaluation time point (discounted 6%)
With QALY as outcome (n = 144)^a
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£353 (–£223 to £929)	£325 (–£223 to £874)
Incremental QALY gain, mean (95% CI)	0.03 (–0.01 to 0.06)	0.03 (–0.01 to 0.06)
ICER (£ per QALY)	£11,767	£10,833
With HADS-T as outcome (n = 156)^b
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£315 (–£210 to £840)	£295 (–£204 to £794)
Incremental HADS-T change (reversed so higher scores show better outcomes), mean (95% CI)	1.63 (–0.61 to 3.88)	1.45 (–0.55 to 3.45)
ICER (£ per unit change on HADS-T)	£193	£203

a: Sample size based on complete data for QALYs and cost measures.
b: Sample size based on complete data for HADS-T and cost measures.
: Discount rate = 3.5%; formula 1/(1+r)ⁿ; r = discount rate, n = years into the future.

TABLE 19

Treatment and cost effects (with 95% CIs) and ICERs following sensitivity analysis adjusting for significant predictors of missing values

Outcome	Incremental differences and ICERs 24-month evaluation time point (discounted 0%)	Incremental differences and ICERs 24-month evaluation time point (discounted 6%)
With QALY as outcome (n = 144)^a
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£308 (–£277 to £893)	£282 (–£277 to £842)
Incremental QALY gain, mean (95% CI)	0.03 (–0.01 to 0.07)	0.03 (–0.01 to 0.06)
ICER (£ per QALY)	£10,267	£9400
With HADS-T as outcome (n = 156)^b
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£264 (–£298 to £825)	£245 (–£292 to £782)
Incremental HADS-T change (reversed so higher scores show better outcomes), mean (95% CI)	2.15 (–0.06 to 4.38)	1.92 (–0.05 to 3.90)
ICER (£ per unit change on HADS-T)	£123	£128

a: Sample size based on complete data for QALYs and cost measures.
b: Sample size based on complete data for HADS-T and cost measures.
: Discount rate = 3.5%; formula 1/(1 + r)ⁿ; r = discount rate, n=years into the future.

TABLE 20

Treatment and cost effects (with 95% CIs) and ICERs, following sensitivity analysis adjusting for baseline imbalances

Outcome	Incremental differences and ICERs 24-month evaluation time point (discounted 0%)	Incremental differences and ICERs 24-month evaluation time point (discounted 6%)
With QALY as outcome (n = 144)^a
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£271 (–£336 to £877)	£248 (–£332 to £828)
Incremental QALY gain, mean (95% CI)	0.03 (–0.01 to 0.06)	0.03 (–0.01 to 0.06)
ICER (£ per QALY)	£9033	£8267
With HADS-T as outcome (n = 156)^b
Incremental health and social care costs (£, 2009–10), mean (95% CI)	£293 (–£269 to £855)	£274 (–£262 to £810)
Incremental HADS-T change (reversed so higher scores show better outcomes), mean (95% CI)	1.44 (–1.01 to 3.90)	1.28 (–0.90 to 3.45)
ICER (£ per unit change on HADS-T)	£203	£214

a: Sample size based on complete data for QALYs and cost measures.
b: Sample size based on complete data for HADS-T and cost measures.
: Discount rate = 3.5%; formula 1/(1 + r)ⁿ; r = discount rate, n = years into the future.

Copyright © Queen’s Printer and Controller of HMSO 2014. This work was produced by Livingston et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK262895

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Livingston G, Barber J, Rapaport P, et al. START (STrAtegies for RelaTives) study: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manual-based coping strategy programme in promoting the mental health of carers of people with dementia. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Technology Assessment, No. 18.61.) Appendix 1, Unit cost of services.
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