Page 169 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

ORT costing

The patient population is defined by attendance at the emergency department. There are
opportunity costs associated with an emergency department attendance (administration,
cleaning, bed changing, etc.) over and above those relating directly to treatment. However, these
opportunity costs do not vary by treatment method and therefore capital costs associated with the
use of emergency department facilities can be excluded from the analysis.
ORT costs therefore include only staff and consumable costs. This is due to the omission of
emergency department related costs and because patients are discharged following treatment in
the emergency department.
Patients undergo a clinical examination prior to receiving ORT; this is done by a specialty registrar.
Patients are then reviewed hourly for the 4 hours they spend in the emergency department; this
takes approximately 5 minutes per hour (total of 20 minutes) and is done by a nurse (band 5).
Patients also receive education/information regarding the treatment they are being given, also
done by a nurse (band 5). This takes approximately 10 minutes.
Table A.3 shows the time taken to carry out ORT-related tasks and the associated costs. Column 2
displays the times used in the base case analysis. The range of times and costs used for both base
case and ‘worst case’ analyses is given in brackets.
Each patient receives an average of two sachets of Dioralyte for ORT, which is given using a
200 ml bottle. Table A.4 summarises the costs for these consumables.
No equipment is required for ORT treatment. It is assumed that all children are discharged from
the emergency department once they have received ORT.

IVT costing
As above for the ORT costing, emergency department attendance costs are omitted from the costing
of IVT. All children on IVT are given approximately 500 ml of sodium chloride 0.9% saline. *

Table A.5 shows the range of time taken to carry out IVT-related tasks and associated costs. Baseline
observations, equipment adjustments and site checks are carried out hourly for the first 4 hours,
i.e. during their time in the emergency department. These are all carried out by a band 5 nurse.
Table A.6 summarises the cost of consumables used in carrying out IVT.
The model assumes that all children on IVT are admitted for an inpatient stay, where they complete
IV treatment. This inpatient stay includes any costs of further treatment during the patient’s stay in
hospital We use the costs of ‘Infectious and non-infectious gastroenteritis without complications
(non-elective)’ as the NHS Healthcare Resource Group (HRG) code for this admission (Table A.7).
The range of costs used for both base case and ‘worst case’ analysis is given in brackets.
Drip stands and infusion pumps are equipment pieces included in the costing of IVT and both of
these are used for the 24 hour period of IVT. Costs for these are shown in Table A.8.
A number of blood tests are carried out when patients are treated with IVT and these are costed
using a ‘Pathology indicative tariff for haematology’ from the NHS National Tariff and are shown
in Table A.9.

Further IVT costing
The model assumes that if a child remains dehydrated after the initial 24 hours of IVT, treatment
continues for another period of 24 hours. Patients receiving further treatment require additional
resources. Further IVT requires a longer inpatient stay and the model assumes that the costs of this
additional stay are given by the difference between the cost of a hospital episode for infectious
and non-infectious gastroenteritis with complications and the cost without complications. This
additional hospital stay is inclusive of any additional labour, consumables or equipment costs.
Table A.10 summarises the hospital costs used in the analysis, and the range of costs used for
both base case and ‘worst case’ analysis are given in brackets.

* In practice, most children are given less than 500 ml of saline. The smallest bag of saline available, however, is of 500 ml and once
opened cannot be reused. The cost used in the analysis therefore is that of a 500 ml bag.

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