Choice of analysis and perspective
A cost-utility analysis using a decision tree was conducted in this
economic evaluation. Maternal quality of life, represented by the mean
EQ-5D-5L scores in the ANODE trial, was used as a measure of benefit and
cost data was recorded in monetary units (£s). The time horizon chosen
is 6-weeks, this is because the majority of maternal infections are
likely to occur within the first 6-7 days following delivery and resolve
within the 6-week time period5. To enable comparison
with the NICE ‘cost-effective’ threshold, the outcomes will be expressed
as cost per QALY. In calculating the QALYs an assumption will be made
that the quality of life (QoL) of patients during the 6-week period is
constant and will be scaled to one year.
The choice of perspective used is the UK’s National Health Service
(NHS). This is because as a publicly funded healthcare system it has a
pressure to deliver cost effective care. Also, the Infection resulting
from operative vaginal delivery impacts both primary and secondary care
services which are both provided by the NHS and so provides a holistic
view of the total economic costs of the intervention.