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Drainage, Irrigation and Fibrinolytic Therapy (DRIFT) for Premature Infants with Posthaemorrhagic Ventricular Dilatation: Health Economic Findings at School Age

Presented at the Neonatal Society 2017 Summer Meeting.

Hollingworth W2, Odd D1, Jary S1, Lea C2,3, Moure Fernandez A2, Blair P2, Young G2, Williams C2, Thai J4, Smith-Collins A2,3, Miller H2, Aquilina K5, Pople I1, Morgan M1, Kmita G6, Whitelaw A2, Luyt K2,3

1 North Bristol NHS Trust
2 University of Bristol, Bristol
3 St. Michael’s Hospital, Bristol
4 CRIC Bristol
5 Great Ormond Street Hospital, London
6 University of Warsaw, Poland

Background: Drainage, irrigation and fibrinolytic therapy (DRIFT) was developed as a novel method to clear the effects of intraventricular haemorrhage (IVH) with post-haemorrhagic ventricular dilatation (PHVD), and has been proven to reduce long-term neurodisability after PHVD. Our aim was to determine whether the initial costs of the intervention were offset by long term savings.

Methods: 10 year follow up of an RCT comparing DRIFT with standard care. 54 children recruited in Bristol are the focus of the economic evaluation. We used micro-costing to estimate the cost of the DRIFT intervention. Information on inpatient care was extracted from hospital notes and linked hospital episode statistics data. Parental questionnaires at 10 years provided data on other health, social and educational resource use and quality of life (EQ5D). Regression models, adjusting for imbalances in randomisation (gender, birth weight and IVH grade) were employed to estimate differences in mean costs between DRIFT and usual care arms.

Results: Participants had DRIFT for an average of 5.2 days at an estimated cost of £1,513 per participant. Fewer participants in the DRIFT arm had reservoir procedures. However, we found no definitive evidence that DRIFT increased or decreased neonatal or other hospital costs up to 10 years (Table). Results were sensitive to adjustment for gender and weight. There was little evidence of a difference in use of ambulatory health and social care at 10 years. A lower proportion of parents in the DRIFT arm reported that their children attended a special school/unit. Due to the high cost of special schooling, this is potentially economically important (Table). In adjusted analyses EQ5D scores were non-significantly higher in survivors in the DRIFT arm.

Drainage, Irrigation and Fibrinolytic Therapy (DRIFT) for Premature Infants with Posthaemorrhagic Ventricular Dilatation: Health Economic Findings at School Age

Conclusion: The DRIFT intervention has a relatively moderate financial cost, but the economic consequences are potentially very large, particularly if it reduces the need for special education in the long-term.

Corresponding author: karen.luyt@bristol.ac.uk

NIHR HTA Programme;12/35/61. NHS Research Ethics approval was granted.

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