Modelo metodológico para minería de datos educativos

Detailed information about secondary care usage was collected and included resources consumed during the late stages of labour to hospital discharge, and during the first 12 months after birth as reported at the 1-year follow-up.Chapter 5reported some data about health-care usage that we also present in this chapter with additional information. Data from trial entry up to postnatal hospital discharge were collected from hospital records and included in the DCB (seeAppendix 1). A postal questionnaire was used to collect secondary care information at the 1-year follow-up, and this was sent by the trial management team, which also dealt with reminders and appropriate double-data entry and data cleaning. Information was collected for women and their babies. The different items of resource use collected for each category of secondary care health service are summarised inTable 18.

No intervention-specific costs were assigned to either upright or lying-down position as neither was

associated with the use of any additional resources . Given that all randomised women already had epidural analgesia and that any remaining medication after the birth was considered to be waste, epidural-specific costs were excluded from the cost analysis. In addition, any top-up epidural drugs costs in both arms were excluded from the cost analysis as there was no evidence of a difference between groups (seeTable 7).

TABLE 18 Categories of resource use and associated unit costs used in the cost analysis (expressed in 2013/14 UK £)

Resource use item

Unit

cost (£) Source Notes

Maternal

Birth related

Augmentation (oxytocin) 1 BNF 201546 _{Oxytocin, injection, price for}

10 units/ml, 1-ml ampoule Fetal blood sampling 28 John Radcliffe Hospital Women’s

Centre (Oxford)

Obtained from hospital finance department

Fetal scalp electrode 5 Schroederet al.47

Hypotension medication 10 BNF 201546

Injection, phenylephrine hydrochloride 10 mg/ml (1%), 1-ml ampoule=£9.91 Mode of birth

Vaginal delivery 1462 NHS Reference Costs 2013–1448

Normal delivery with a complication score of 0 (HRG data)

Assisted delivery 1860 NHS Reference Costs 2013_–1448 _{Assisted delivery with a complication}

score of 0 (HRG data) Caesarean section delivery 3674 NHS Reference Costs 2013–1448

TABLE 18 Categories of resource use and associated unit costs used in the cost analysis (expressed in 2013/14 UK £) (continued)

Resource use item

Unit

cost (£) Source Notes

Episiotomy 27 Schroederet al.47

Perineal tear

First- and second-degree tears 23 Schroederet al.47

Third- and fourth-degree tears 64 Schroederet al.47

Manual removal of the placenta 74 Schroederet al.47

Post-partum haemorrhage 154 Eddamaet al.49

Blood transfusion 157 Schroederet al.47 _{Per blood pack}

HLC admissions

Level of care (per day)

Level 0 643 NHS Reference Costs 2013–1448

Level 1 890 NHS Reference Costs 2013_–1448

Level 2 1266 NHS Reference Costs 2013–1448

Level 3 1449 NHS Reference Costs 2013_–1448

Investigations

MRI 139 NHS Reference Costs 2013_–1448

CT 80 NHS Reference Costs 2013–1448

Radiography 48 NHS Reference Costs 2013_–1448

Transfer to another hospital 435 Schroederet al.47

Outpatient visits

Perineal care clinic 13 NHS Reference Costs 2013–1448

Gynaecological 13 NHS Reference Costs 2013_–1448

Surgical 11 NHS Reference Costs 2013–1448

Other 127 _– Average cost of outpatient visits

Hospital visits

Hospital inpatient (per day) 757 NHS Reference Costs 2013_–1448 _{Average cost of regular day or}

night admissions Postnatal ward stay (per day) 103 Schroederet al.47

Infant

Birth related

Cord blood sampling 0.05 Schroederet al.47

HLC admissions

Level of care (per day)

Special care 41 NHS Reference Costs 2013–1448

High dependency 839 NHS Reference Costs 2013_–1448

Intensive care 1118 NHS Reference Costs 2013–1448

continued

DOI: 10.3310/hta21650 HEALTH TECHNOLOGY ASSESSMENT 2017 VOL. 21 NO. 65

© Queen’s Printer and Controller of HMSO 2017. This work was produced by Bicket 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.

At the study design stage, there was a general concern about including primary care and community care visits as part of the data collection because these tend to be frequent and poorly recalled by new mothers compared with secondary care visits.50_{It was agreed that hospital care constituted the main cost driver for this} population and the target source data to collect in the study. Therefore, primary care and community care visit data were not collected. However, urinary and faecal incontinence are important outcomes following birth and may be related to the mode of delivery, and can have long-lasting effects on HRQoL and additional visits to primary care.17,21_{Therefore, it was decided that, if necessary, primary care visits related to these} adverse events would be estimated using recent data from the literature if significant differences between treatment arms were observed. Nevertheless, this was not the case (seeTable 14), and such visits were not incorporated as part of the categories of resource use in the cost analysis and are presented as part of the health outcomes in the cost–consequences analysis. We also assumed that any costs for specific surgeries were reflected in the length of stay and the unit cost attached to the admission. Therefore, we did not conduct a micro-costing approach for the maternal and infant surgeries performed in different time periods.