Title: Evaluation of patient preferences for and cost effectiveness of community intravenous antibiotic services
Funder: Department of Health (England)

Abstract: We will undertake a systematic review of the published literature to evaluate both quantitative and qualitative information on existing models of care identifying their associated costs efficacy and safety. We will conduct a discrete choice experiment (DCE) to determine patients’ preferences for different models of home versus hospital treatment. The DCE involves respondents stating their preference for treatment options having been presented with a set of treatment attributes and varying levels for each. The attributes and levels chosen for the DCE would be derived from a thematic analysis of qualitative focus groups with relevant patients (n=30) published literature and clinical expert guidance. The specific combinations used in each scenario will be determined on the grounds of statistical efficiency. The survey will be conducted via interviews using a laptop with interview design following best practice. After development the DCE interview will be piloted in a small group of patients (n=30). The main survey will include samples from two adult groups with short-term (n=100) and longer-term infections (n=100). The survey will also collect socioeconomic details and health status (e.g. the EQ-5D). The DCE data will be analysed using advanced mathematical structures belonging to the family of random utility models. Patients will be recruited (as they receive current treatment or retrospectively from records) from Leeds Bradford and Mid Yorkshire Acute Trusts who between them provide each of the services under investigation. Ethical approval will be sought for the study. Economic model to estimate the comparative value of provision of antibiotics at home versus hospital: The simulation model will allow comparisons of the expected costs and benefits of the services. The input values (NHS resource use and costs treatment efficacy event and risk probabilities and health status) for the economic model will be derived from the literature review clinical experts patient interviews and retrospective investigation of hospital and GP records. The model outputs will be a set of incremental cost-effectiveness ratios comparing various IV services available. A probabilistic sensitivity analysis would be conducted to evaluate the sensitivity of the model’s outputs to the model input parameter values. Expert Panel Workshop: This will take the form of a consensus workshop to consider the evidence collected in the work streams Membership of the panel will consist of 2-4 service user representatives together with health care staff currently involved in IV antibiotic delivery pharmacists and a health economist. The aim will be to consider and reach consensus on what represents optimal community IV therapy for the two patient groups and to consider the design of future clinical trials to test this model of care. Our Patient Advisory Group will contribute to the management of the project; the qualitative work; the expert panel and the dissemination strategy.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: GENERIC HEALTH RELEVANCE