Work Package 5: Health economic impacts

Health economic impacts of mirtazapine on the costs associated with breathlessness

Lead partner: Trinity College Dublin (TCD)

Breathlessness has a direct effect on the health and quality of life of patients, and can affect use of services and burden on caregivers.  Along with effects on measured breathlessness, it is important to assess the cost-effectiveness of mirtazapine, care needs and caregiver burden.

Eligible patients are frequent users of primary care and hospital services.  Small changes in symptoms may affect service use and care needs.  Changes in costs are likely to be driven by changes in hospital admissions and use of ambulatory care.  Importantly there may be effects on informal care and caregiver burden.  We plan to assess the effects of mirtazapine on use of hospital and community health services, on needs for informal care and on the burden on caregivers.

Information on service use and informal care will be collected from all study participants and their caregivers, using the Client Services Receipt Inventory (a widely used tool for measuring service use), and data directly from records where available.  Unit costs will be assessed for each country to allow total costs to be calculated.   

It is common in economic evaluation studies to use a generic tool to measure quality of life (such as).  To measure effects on quality of life we will use the Euroqol EQ5D.  Since studies have questioned the sensitivity of EQ5D for effects on people with complex needs, we will also use measurement tools that have been applied in this setting to assess outcomes.   We will also measure the effects on caregiver burden.

Mirtazapine will be shown to be cost-effective if costs are lower and outcomes are the same or better, or if costs are the same and outcome are clearly better.  It may also be cost-effective if costs are higher but outcomes are much better.