Chapter 4 (health-economic) literature reviews and additional analyses

Fiona Lecky; Wanda Russell; Gordon Fuller; Graham McClelland; Elspeth Pennington; Steve Goodacre; Kyee Han; Andrew Curran; Damien Holliman; Jennifer Freeman; Nathan Chapman; Matt Stevenson; Sonia Byers; Suzanne Mason; Hugh Potter; Tim Coats; Kevin Mackway-Jones; Mary Peters; Jane Shewan; Mark Strong

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Lecky F, Russell W, Fuller G, et al. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study. Southampton (UK): NIHR Journals Library; 2016 Jan. (Health Technology Assessment, No. 20.1.)

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

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Appendix 7Chapter 4 (health-economic) literature reviews and additional analyses

Cost-effectiveness model sensitivity analyses

Parameter uncertainty sensitivity analyses

TABLE 36

Best- and worst-case scenario analyses examining the influence of bypass parameters on model results

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Bypass: best case	Bypass	25,996	13.28	239,530	7530	1.00	0.00	372,293	10,733	1.00	0.00
	Selective transfer	27,119	12.96	232,000	0	0.00	1.00	361,560	0	0.00	1.00
	Routine transfer	27,270	13.02	233,033	1033	0.00	1.00	363,185	1625	0.00	1.00
	No transfer	26,876	12.68	226,818	–5182	0.00	1.00	353,664	–7896	0.00	1.00
Bypass: worst case	Bypass (observed)	31,862	12.94	226,962	–4744	0.00	1.00	356,374	–4656	0.00	1.00
	Selective transfer	26,942	12.93	231,706	0	0.22	0.78	361,030	0	0.20	0.80
	Routine transfer	27,094	12.99	232,746	1040	0.77	0.23	362,666	1636	0.79	0.21
	No transfer	26,714	12.66	226,484	–5222	0.01	0.99	353,083	–7947	0.01	0.99

: Strategy with highest net benefit denoted by shading. Bypass relative effectiveness and inpatient cost parameters fixed at the 2.5th/97.5th quantiles. Other parameters treated probabilistically. Selective transfer is baseline comparator for calculation of mean incremental NMB.

TABLE 37

Threshold analysis examining the value of bypass parameters required for cost-effectiveness

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Bypass: threshold analysis	Bypass	28,458	13.14	234,419	2174	0.75	0.25	365,857	4100	0.85	0.16
	Selective transfer	26,779	12.95	232,245	0	0.00	1.00	361,757	0	0.00	1.00
	Routine transfer	26,927	13.01	233,334	1089	0.22	0.78	363,465	1708	0.15	0.85
	No transfer	26,510	12.68	227,103	–5142	0.00	1.00	353,909	–7848	0.00	1.00

: Results are shown for scenario where distributions for bypass parameters are set at the most favourable 0.05th quantile from the median value.
: Strategy with highest net benefit denoted by shading. Bypass relative effectiveness and inpatient cost parameters fixed at the 55th quantile. Other parameters treated probabilistically. Selective transfer is baseline comparator for calculation of mean incremental NMB.

TABLE 38

Probabilistic sensitivity analysis examining the influence of alternative utility estimates

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Utility estimates (Aoki et al.⁷⁷)	Bypass	29,045	12.74	225,709	433	0.43	0.57	353,086	1670	0.48	0.52
	Selective transfer	27,005	12.61	225,275	0	0.12	0.88	351,416	0	0.09	0.91
	Routine transfer	27,160	12.67	226,287	1012	0.43	0.57	353,011	1595	0.41	0.59
	No transfer	26,774	12.32	219,718	–5557	0.01	0.99	342,964	–8452	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 39

Probabilistic sensitivity analysis examining the influence of alternative estimates for baseline outcomes for patients requiring acute neurosurgery

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Alternative acute neurosurgery baseline outcomes (Taussky et al.⁷⁶)	Bypass	29,621	13.02	230,684	750	0.45	0.55	360,837	2256	0.52	0.48
	Selective transfer	27,361	12.86	229,934	0	0.09	0.91	358,581	0	0.07	0.93
	Routine transfer	27,492	12.93	231,011	1077	0.44	0.56	360,262	1681	0.4	0.6
	No transfer	27,105	12.59	224,769	–5165	0.01	0.99	350,707	–7874	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 40

Probabilistic sensitivity analysis examining the influence of alternative specification of incremental costs for the acute neurosurgery subgroup

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Neurosurgery (transfer costs only)	Bypass	27,322	13.09	234,520	2957	0.62	0.38	365,441	4575	0.65	0.35
	Selective transfer	27,043	12.93	231,563	0	0.05	0.95	360,866	0	0.04	0.96
	Routine transfer	27,170	12.99	232,693	1130	0.31	0.69	362,624	1758	0.31	0.69
	No transfer	26,856	12.66	226,342	–5221	0.01	0.99	352,940	–7926	0	1
Neurosurgery (NHIR incremental costs)	Bypass	27,865	13.1	234,225	2417	0.58	0.42	365,270	4046	0.62	0.38
	Selective transfer	27,024	12.94	231,808	0	0.07	0.93	361,224	0	0.06	0.94
	Routine transfer	27,173	13	232,855	1047	0.33	0.67	362,868	1644	0.32	0.68
	No transfer	26,779	12.68	226,728	–5080	0.01	0.99	353,481	–7743	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 41

Probabilistic sensitivity analysis examining the influence of alternative specification of relative effectiveness for major extracranial injury associated with bypass

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Mean incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Mean incremental NMB (£)	Probability cost-effective	Error
Bypass incremental costs (expert opinion)	Bypass	27,175	13.06	234,065	2611	0.60	0.40	364,684	3926	0.61	0.39
	Selective transfer	27,156	12.93	231,453	0	0.06	0.94	360,758	0	0.05	0.95
	Routine transfer	27,278	12.99	232,579	1126	0.34	0.66	362,508	1749	0.34	0.66
	No transfer	26,920	12.66	226,261	–5192	0.01	0.99	352,852	–7906	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 42

Probabilistic sensitivity analysis examining the influence of alternative specification of relative effectiveness for major extracranial injury associated with bypass

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Mean incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Mean incremental NMB (£)	Probability cost-effective	Error
Elicited or for extracranial injury	Bypass	28,906	13.09	232,902	651	0.42	0.58	363,805	2008	0.48	0.52
	Selective transfer	26,843	12.95	232,251	0	0.10	0.90	361,798	0	0.07	0.93
	Routine transfer	26,984	13.02	233,320	1069	0.46	0.54	363,472	1674	0.44	0.56
	No transfer	26,583	12.68	226,994	–5257	0.01	0.99	353,782	–8015	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 43

Probabilistic sensitivity analysis examining the influence of alternative specification of suspected significant TBI population case mix

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Population subgroups: NEAS estimate	Bypass	27,762	13.25	237,291	567	0.43	0.57	369,818	1557	0.47	0.53
	Selective transfer	26,351	13.15	236,724	0	0.1	0.9	368,261	0	0.08	0.92
	Routine transfer	26,527	13.22	237,778	1054	0.45	0.55	369,930	1669	0.44	0.56
	No transfer	26,127	12.89	231,585	–5139	0.01	0.99	360,441	–7820	0.01	0.99
Population subgroups: NWAS estimate	Bypass	36,373	12.29	209,535	4315	0.61	0.39	332,454	9147	0.7	0.3
	Selective secondary transfer	30,954	11.81	205,220	0	0.06	0.94	323,307	0	0.04	0.96
	Routine transfer	30,843	11.88	206,688	1468	0.3	0.7	325,453	2146	0.26	0.74
	No transfer	30,699	11.5	199,237	–5983	0	1	314,205	–9102	0	1

: Strategy with highest net benefit denoted by shading.

TABLE 44

Probabilistic sensitivity analysis examining the influence of assumptions regarding post-discharge costs

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Post-discharge costs^a	Bypass	14,892	13.07	246,533	324	0.43	0.57	377,246	1666	0.48	0.52
	Selective transfer	12,532	12.94	246,209	0	0.12	0.88	375,580	0	0.09	0.91
	Routine transfer	12,935	13.00	247,008	799	0.43	0.57	376,980	1400	0.41	0.59
	No transfer	11,701	12.67	241,612	–4598	0.01	0.99	368,268	–7312	0.01	0.99

a: Post-discharge TBI (first-year and longer-term) costs set to the 2.5th quantile of their elicited probability distributions.
: Strategy with highest net benefit denoted by shading.

TABLE 45

Probabilistic sensitivity analysis examining the influence of increased mortality rates in head injury and major trauma patients

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Decreased life expectancy	Bypass	25,693	11.49	204,187	1372	0.51	0.49	319,127	2794	0.56	0.44
	Selective transfer	24,222	11.35	202,815	0	0.08	0.92	316,333	0	0.06	0.94
	Routine transfer	24,398	11.41	203,742	927	0.39	0.61	317,812	1479	0.37	0.63
	No transfer	23,913	11.12	198,491	–4324	0.01	0.99	309,692	–6641	0.01	0.99

: Strategy with highest net benefit denoted by shading.

Structural sensitivity analyses

TABLE 46

Probabilistic sensitivity analysis examining the influence of the relative effectiveness proportional odds assumption

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Modifying the proportional odds assumption^a	Bypass	29,027	13.05	231,986	648	0.48	0.52	362,493	1975	0.55	0.45
	Selective transfer	27,020	12.92	231,338	0	0.12	0.88	360,517	0	0.09	0.91
	Routine transfer	27,044	12.96	232,107	769	0.38	0.62	361,683	1166	0.36	0.64
	No transfer	28,366	12.68	225,294	–6044	0.01	0.99	352,123	–8394	0.01	1.00

a: Odds ratio for unfavourable outcome is applied, but the proportions of patients in each constituent GOS category of the dichotomised outcome group is determined by the baseline risk.
: Strategy with highest net benefit denoted by shading.

TABLE 47

Probabilistic sensitivity analysis examining the influence of discount rate on model results

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Discount rate 1.5%	Bypass (observed)	35,088	17.06	306,172	2476	0.55	0.45	476,803	4561	0.59	0.41
	Selective transfer	33,397	16.85	303,696	0	0.06	0.94	472,242	0	0.05	0.95
	Routine transfer	33,416	16.93	305,275	1579	0.37	0.63	474,620	2378	0.36	0.64
	No transfer	33,368	16.50	296,614	–7082	0.01	0.99	461,606	–10,636	0.00	1.00
Discount rate 6.0%	Bypass	24,231	9.97	175,161	283	0.42	0.58	274,857	1513	0.48	0.52
	Selective transfer	22,054	9.85	174,878	0	0.12	0.88	273,344	0	0.09	0.91
	Routine transfer	22,270	9.89	175,614	736	0.45	0.56	274,557	1213	0.42	0.58
	No transfer	21,659	9.64	171,195	–3683	0.01	0.99	267,622	–5722	0.01	0.99

: Strategy with highest net benefit denoted by shading.

TABLE 48

Probabilistic sensitivity analysis examining theoretical strategies of pre-hospital triage with full compliance and no transfer with no referral of patients requiring acute neurosurgery

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Alternative comparators	Bypass	29,591	13.12	232,889	1466	0.49	0.51	364,129	3432	0.58	0.42
Bypass: 100% compliance	Selective transfer	27,126	12.93	231,423	0	0.09	0.91	360,697	0	0.06	0.94
No transfer: no neurosurgical transfers	Routine transfer	27,265	12.99	232,543	1120	0.40	0.60	362,447	1750	0.35	0.65
No transfer: no neurosurgical transfers	No transfer	30,333	12.55	220,607	–10,816	0.00	1.00	346,076	–14,621	0.00	1.00

: Strategy with highest net benefit denoted by shading.

TABLE 49

Probabilistic sensitivity analysis examining non-direct health effects of bypass

Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	λ = £20,000				λ = £30,000
Sensitivity analysis	Strategy	Mean cost (£)	Mean QALY	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error	Mean NMB (£)	Incremental NMB (£)	Probability cost-effective	Error
Utility decrement for bypassing mild TBI cases	Bypass	28,934	13.04	231,955	509	0.42	0.58	362,399	1664	0.48	0.52
	Selective transfer	27,133	12.93	231,446	0	0.10	0.90	360,735	0	0.07	0.93
	Routine transfer	27,259	12.99	232,557	1111	0.46	0.54	362,465	1730	0.44	0.56
	No transfer	26,904	12.65	226,188	–5257	0.01	0.99	352,735	–8001	0.01	0.99

: Strategy with highest net benefit denoted by shading.

Expected value of perfect information

TABLE 50

Individual and population EVPI for model parameters at different cost-effectiveness thresholds, under different assumptions for population that might benefit from future research

Assumption	Individual EVPI (£) (λ =)						Population EVPI (£) (λ =)
Assumption	£0	£10,000	£20,000	£30,000	£40,000	£50,000	£0	£10,000	£20,000	£30,000	£40,000	£50,000
Base case	445	986	1807	2594	2927	3292	8,756,236	19,416,946	35,589,507	51,079,936	57,648,281	64,824,398
Optimistic scenario	445	986	1807	2594	2927	3292	17,366,923	38,511,136	70,587,431	101,310,801	114,338,310	128,571,260
Pessimistic scenario	445	986	1807	2594	2927	3292	2,674,605	5,930,934	10,870,866	15,602,439	17,608,750	19,800,705

Expected value of partial perfect information

TABLE 51

Individual EVPPI for model parameters under base-case assumptions

Parameter category	Relevant model inputs	Input type	Population EVPPI (£) at λ =
Parameter category	Relevant model inputs	Input type	£0	£10,000	£20,000	£30,000	£40,000	£50,000
Population subgroups	Mild TBI	Proportion	0	0	0	1	0	0
	Acute neurosurgery	Proportion	0	0	18	260	150	106
	Head injury requiring critical care	Proportion	0	0	0	172	64	29
	Head injury requiring ward care	Proportion	0	0	0	28	0	0
	Major extracranial injury	Proportion	0	0	3	42	0	0
Relative effectiveness outcomes (vs. selective transfer)	Acute neurosurgery: SNC care	Proportional odds ratio	0	20	302	728	654	623
	TBI requiring critical care: bypass	Proportional odds ratio	15	511	1322	2133	2388	2664
	TBI requiring critical care: routine transfer	Proportional odds ratio	39	16	250	616	499	435
	TBI requiring critical care: no transfer	Proportional odds ratio	0	25	21	41	13	11
	TBI requiring ward care: bypass	Proportional odds ratio	0	0	1	32	0	0
	Major extracranial injury: bypass	Odds ratio	0	0	0	4	0	0
Inpatient costs (vs. selective transfer)	Mild TBI: bypass	Incremental cost	0	0	0	104	33	28
	Acute neurosurgery: SNC care	Incremental cost	3	40	161	340	114	27
	TBI requiring critical care: bypass	Incremental cost	74	251	472	694	424	241
	TBI requiring critical care: routine transfer	Incremental cost	0	0	0	1	0	0
	TBI requiring critical care: no transfer	Incremental cost	1	0	0	0	0	0
	TBI requiring ward care: bypass	Incremental cost	0	0	0	36	0	0
	Major extracranial injury: bypass	Incremental cost	0	0	2	78	1	0
First-year post-discharge costs	GOS severe disability	Mean cost	0	0	0	18	0	0
	GOS moderate disability	Mean cost	0	0	0	1	0	0
	GOS good recovery	Mean cost	0	0	1	4	0	0
	EC injury survivors	Mean cost	0	0	0	0	0	0
Long-term costs	GOS severe disability	Mean cost	43	0	0	2	0	0
	GOS moderate disability	Mean cost	0	0	0	2	0	0
	GOS good recovery	Mean cost	0	0	8	73	0	0
	EC injury survivors	Mean cost	0	0	0	22	0	0
Utilities	GOS severe disability	Mean utility	0	0	0	31	0	0
	GOS moderate disability	Mean utility	0	0	0	1	0	0
	GOS good recovery	Mean utility	0	0	0	40	0	0
	EC injury survivors	Mean utility	0	0	0	8	0	0

: EC, extracranial.

TABLE 52

Population EVPPI for model parameters under base-case assumptions

Parameter category	Relevant model inputs	Input type	Population EVPPI (£) at λ =
Parameter category	Relevant model inputs	Input type	£0	£10,000	£20,000	£30,000	£40,000	£50,000
Population subgroups	Mild TBI	Proportion	0	0	0	20,744	0	0
	Acute neurosurgery	Proportion	0	0	347,385	5,125,420	2,945,377	2,094,278
	Head injury requiring critical care	Proportion	4551	0	78	3,395,577	1,265,634	573,440
	Head injury requiring ward care	Proportion	0	0	0	545,185	0	0
	Major extracranial injury	Proportion	0	7741	52,908	820,492	0	0
Relative effectiveness outcomes (vs. selective transfer)	Acute neurosurgery: SNC care	Proportional odds ratio	0	387,949	5,950,242	14,341,036	12,887,713	12,273,609
	TBI requiring critical care: bypass	Proportional odds ratio	291,628	10,053,152	26,030,719	42,001,498	47,032,039	52,453,233
	TBI requiring critical care: routine transfer	Proportional odds ratio	770,554	320,195	4,918,315	12,131,555	9,828,163	8,565,781
	TBI requiring critical care: no transfer	Proportional odds ratio	0	496,243	407,628	808,166	254,226	212,872
	TBI requiring ward care: bypass	Proportional odds ratio	0	0	13,981	622,469	1969	0
	Major extracranial injury: bypass	Odds ratio	0	0	0	70,892	0	0
Inpatient costs (vs. selective transfer)	Mild TBI: bypass	Incremental cost	0	0	0	2,042,851	643,573	553,572
	Acute neurosurgery: SNC care	Incremental cost	58,426	784,175	3,173,639	6,698,113	2,252,809	525,606
	TBI requiring critical care: Bypass	Incremental cost	1,465,843	4,941,885	9,303,495	13,673,458	8,343,931	4,750,486
	TBI requiring critical care: routine transfer	Incremental cost	0	0	0	10,129	0	0
	TBI requiring critical care: no transfer	Incremental cost	12,809	0	0	0	0	0
	TBI requiring ward care: bypass	Incremental cost	0	0	0	709,539	807	0
	Major extracranial injury: bypass	Incremental cost	0	0	45,775	1,539,086	12,438	0
First-year post-discharge costs	GOS severe disability	Mean cost	0	0	0	363,534	0	0
	GOS moderate disability	Mean cost	4	0	0	28,111	0	0
	GOS good recovery	Mean cost	0	0	15,928	69,894	0	0
	EC injury survivors	Mean cost	0	0	0	0	0	0
Long-term costs	GOS severe disability	Mean cost	839,124	0	0	44,478	0	0
	GOS moderate disability	Mean cost	51	0	0	47,796	0	0
	GOS good recovery	Mean cost	0	0	152,706	1,440,957	0	0
	EC injury survivors	Mean cost	0	0	0	437,994	0	0
Utilities	GOS severe disability	Mean utility	0	0	0	608,237	0	0
	GOS moderate disability	Mean utility	0	0	0	11,555	0	0
	GOS good recovery	Mean utility	0	0	0	787,818	0	0
	EC injury survivors	Mean utility	0	0	0	153,447	0	0

: EC, extracranial.
: Model inputs denoted by shading have large expected values of partial perfect information at NICE willingness-to-pay thresholds (> £0.5M).

TABLE 53

Individual and population EVPPI for model parameters, grouped by potential study design, under optimistic assumptions for population that might benefit from future research

Model parameter	Optimistic scenario						Pessimistic scenario
	Population EVPPI (λ = )						Population EVPPI (λ =)
	£0	£10,000	£20,000	£30,000	£40,000	£50,000	£0	£10,000	£20,000	£30,000	£40,000	£50,000
Patient subgroups	818	0	1,714,159	12,370,184	7,986,953	6,158,436	126	0	264,005	1,905,187	1,230,106	948,488
TBI utilities	0	7443	558,526	4,421,639	1,291,890	716,864	0	1146	86,021	680,996	198,970	110,407
Post-discharge costs	1,755,955	11,120	751,228	5,392,692	1,024,809	490,302	270,443	1713	115,700	830,553	157,835	75,514
Bypass: relative effectiveness^a	812,668	21,724,345	54,793,856	87,830,169	99,243,879	111,251,485	125,163	3,345,863	8,439,046	13,527,116	15,284,993	17,134,338
Bypass: inpatient costs^a	4,639,278	12,995,632	22,287,924	31,067,488	20,106,639	12,487,650	714,516	2,001,515	3,432,663	4,784,843	3,096,713	1,923,279

a: Compared with selective transfer.

Expected net benefit of sampling

Expected net benefit of sampling under optimistic assumptions for recruitment and technology lifespan

TABLE 54

Expected net benefit of sampling and study characteristics of definitive HITS-NS trial with differing sample sizes under optimistic assumptions

FIGURE 28

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £20,000 (optimistic assumptions).

FIGURE 29

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £30,000 (optimistic assumptions).

Expected net benefit of sampling under pessimistic assumptions for recruitment and technology lifespan

TABLE 55

Expected net benefit of sampling and study characteristics of definitive HITS-NS trial with differing sample sizes under pessimistic assumptions

TABLE 56

Expected net benefit of sampling and study characteristics of definitive HITS-NS trial with differing sample sizes under assumptions consistent with originally envisaged definitive HITS-NS trial

FIGURE 30

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £20,000 (pessimistic assumptions).

FIGURE 31

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £30,000 (pessimistic assumptions). Expected net benefit of sampling under assumptions consistent with initially envisaged definitive HITS-NS trial.

FIGURE 32

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £20,000 (originally planned definitive HITS-NS trial assumptions).

FIGURE 33

Expected net benefit of sampling for a definitive HITS-NS cluster randomised trial at λ = £30,000 (originally planned definitive HITS-NS trial assumptions).

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