5 Committee members and NICE project team

Committee members

This topic was considered by NICE's medical technologies advisory committee, which is a standing advisory committee of NICE.

Committee members are asked to declare any interests in the technology to be appraised. If it is considered there is a conflict of interest, the member is excluded from participating further in that evaluation.

The minutes of the medical technologies advisory committee, which include the names of the members who attended and their declarations of interests, are posted on the NICE website.

NICE project team

Each medical technologies guidance topic is assigned to a team consisting of 1 or more health technology assessment analysts (who act as technical leads for the topic), a health technology assessment adviser and a project manager.

Federica Ciamponi
Health technology assessment analyst

Kimberley Carter
Health technology assessment adviser

Victoria Fitton
Project manager

ISBN: [to be added at publication]

Addendum 1: Corrected Training Costs

Impact of Calculation Correction on Cost Savings

A calculation error in the cost of training has been corrected by the EAC. Training costs have been reduced to £62.16 per patient. The impact of this change has been to increase the cost savings associated with inhaled sedation using the AnaConDa device when compared with propofol.

Table 1: Propofol versus Isoflurane

Model	Cost of Intervention (Inhaled isoflurane using AnaConDa-S)		Cost of Comparator (IV Propofol)		Cost Saving
Company Base-case	£15,999.43		£19,647.73		£3,648.31
EAC Preferred Values	£18,703.83		£23,097.03		£4,393.20
Scenario 1: Days on ventilation are different for the sedation methods
Company Scenario 1 (difference in ventilator days and ICU days between IV and inhaled sedation)		£15,507		£20,004		£4,497
Using EAC Preferred Values		£17,842.21		£23,797.63		£5,955.42
Scenario 2: ICU length of stay for total study population
Company Scenario 2 (difference in ventilator days and ICU day in population including switchers)		£20,107.00		£21,141.66		£1,034.66
Using EAC Preferred Values		£23,166.41		£25,300.15		£2,133.74
Scenario 3: Sevoflurane for inhaled sedation
EAC Additional Scenario: Sevoflurane for inhaled sedation with AnaConDa		£19,751.42		£23,097.03		£3,345.61

Similarly, the reduction in training costs results in increased cost savings with AnaConDa compared with Midazolam (table 2).

Table 2: Midazolam versus Isoflurane

Model	Cost of Intervention (Inhaled isoflurane using AnaConDa-S)	Cost of Comparator (IV Midazolam)	Cost Saving
Company Scenario	£10,161.28	£15,919.55	£5,758
EAC preferred inputs (Adult patients)	£12,508.88	£19,157.57	£6,648.69
EAC preferred inputs (Pediatric Patients)	£6,883.58	£9,720.99	£3,396.85

Sensitivity Analysis (AnaConDa vs Propofol)

Updated sensitivity analysis suggests that with the lower cost of training, AnaConDa remains cost saving even when duration of ICU stay is slightly longer with AnaConDa. This is because, with changes the EAC made to propofol costs (see Assessment Report) the cost of sedation with AnaConDa becomes marginally cheaper than with propofol per patient per day.

The EAC note that there is considerable uncertainty around the accuracy of the training costs and should be considered with caution.

Addendum 2: Breakdown of costs and impact of removing daily sedation interruption and dose renewals

During the draft guidance meeting, the clinical experts requested a breakdown of the costs by sedation approach. This information is presented below – it should be noted that all results are based on a corrected cost of training.

Daily Sedation Interruption and Dose Renewals: These are included in the model for IV Sedation (Propofol) only.

The costs in the model are outlined in table 3.

Table 3: Cost by sedation approach

Sedation Approach	Cost per patient per day	Total cost for duration of sedation (10.9 days)
Propofol	£152.01 £43.34 is the cost of Propofol and £108.67 is the cost of the daily sedation interruption/dose renewal.	£1,656.94
Isoflurane	£95.76 £10.16 is the cost of isoflurane and £85.60 is the additional equipment costs for AnaConDa	£1,043.83

Sedation Approach

Cost per patient per day

Total cost for duration of sedation (10.9 days)

Propofol

£152.01

£43.34 is the cost of Propofol and £108.67 is the cost of the daily sedation interruption/dose renewal.

£1,656.94

Isoflurane

£95.76

£10.16 is the cost of isoflurane and £85.60 is the additional equipment costs for AnaConDa

£1,043.83

Based on the corrected training costs, if the daily sedation interruption and dose renewal costs are removed from the model, the cost savings associated with AnaConDa reduce from £4,393.20 to £3,208.71. This is for the base case, where the duration of ventilation is the same in both arms. In two-way sensitivity analysis (table 2), again with duration of ventilation equal in both arms, AnaConDa remains cost saving provided there is a reduction of 0.7 days overall ICU stay.

The impact of removing the daily sedation interruption and dose renewal costs on cost savings for each of the scenarios is outlined in table 4.

Table 4: Cost savings without daily sedation interruption and dose renewal for scenarios (based on corrected training costs)

Scenario	Company	EAC (with daily sedation interruption and dose renewal)	EAC (without daily sedation interruption and dose renewal)
Difference in ventilation days	£4,497	£5,955.42	£4,462.26
Mechanical ventilation and ICU duration for the whole population (switchers included)	£1,034.66	£2,133.74	£721.05
Sevoflurane	N/A	£3,345.61	£2,161.12

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AnaConDa-S for sedation with volatile anaesthetics in intensive care