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Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: Conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR)

Mariamma M Thalanany1, Miranda Mugford1*, Clare Hibbert2, Nicola J Cooper3, Ann Truesdale4, Steven Robinson4, Ravindranath Tiruvoipati56, Diana R Elbourne4, Giles J Peek5, Felicity Clemens4, Polly Hardy47, Andrew Wilson3 and The CESAR Trial Group

Author Affiliations

1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK

2 Health Economics & Decision Science, School of Health & Related Research, University of Sheffield, S1 4DA, UK

3 Department of Health Sciences, University of Leicester, LE1 7RH, UK

4 London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK

5 Glenfield Hospital, Leicester, UK, LE3 9QP, UK

6 Frankston Hospital, Victoria, 3199, Australia

7 Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Australia

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BMC Health Services Research 2008, 8:94  doi:10.1186/1472-6963-8-94

Published: 30 April 2008



Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis. Given the high cost of treatment, ECMO is considered an expensive technology for many funding systems. However, conventional treatment for severe respiratory failure is also one of the more costly forms of care in any health system.


The objectives of the economic evaluation are to compare the costs of a policy of referral for ECMO with those of conventional treatment; to assess cost-effectiveness and the cost-utility at 6 months follow-up; and to assess the cost-utility over a predicted lifetime. Resources used by patients in the trial are identified. Resource use data are collected from clinical report forms and through follow up interviews with patients. Unit costs of hospital intensive care resources are based on parallel research on cost functions in UK NHS intensive care units. Other unit costs are based on published NHS tariffs. Cost effectiveness analysis uses the outcome: survival without severe disability. Cost utility analysis is based on quality adjusted life years gained based on the Euroqol EQ-5D at 6 months. Sensitivity analysis is planned to vary assumptions about transport costs and method of costing intensive care. Uncertainty will also be expressed in analysis of individual patient data. Probabilities of cost effectiveness given different funding thresholds will be estimated.


In our view it is important to record our methods in detail and present them before publication of the results of the trial so that a record of detail not normally found in the final trial reports can be made available in the public domain.

Trial Registrations

The CESAR trial registration number is ISRCTN47279827.