{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:09:34Z","timestamp":1788858574530,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["130573"],"award-info":[{"award-number":["130573"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Total intravenous and inhalational anaesthesia are used widely to maintain general anaesthesia for major non\u2010cardiac surgery, yet their comparative cost\u2010effectiveness remains uncertain. The VITAL trial evaluated clinical outcomes, showing no difference in days alive and at home at 30\u2009days. We conducted an economic evaluation alongside VITAL to determine whether total intravenous anaesthesia offers an economic advantage within the UK NHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A within\u2010trial economic evaluation was conducted from the NHS and personal social services perspective over a 6\u2010month time horizon. Resource use was collected from trial records and questionnaires, and health\u2010related quality of life was measured using EuroQol five\u2010dimension five\u2010level instrument at baseline, discharge, 30\u2009days and 6\u2009months. Costs were evaluated using national sources and quality\u2010adjusted life years were calculated using the area under the curve approach. Incremental cost\u2010effectiveness ratios were estimated using imputed datasets, with uncertainty explored through bootstrapping and the probability of cost\u2010effectiveness illustrated using a cost\u2010effectiveness acceptability curve across a range of willingness\u2010to\u2010pay thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2507 patients were allocated randomly: 1253 (50%) received total intravenous anaesthesia; and 1254 (50%) inhalational anaesthesia. Mean costs and quality\u2010adjusted life years were similar across groups. Incremental cost was \u2010\u00a3145 (95%CI \u2010\u00a31510\u2013\u00a31220) and incremental quality\u2010adjusted life years \u20100.001 (95%CI \u20100.008\u20130.005). Total intravenous anaesthesia showed a 56\u201357% probability of cost\u2010effectiveness at standard willingness\u2010to\u2010pay thresholds. Sensitivity analyses, including complete\u2010case and societal\u2010perspective models, yielded consistent findings of equivalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Total intravenous and inhalational anaesthesia show comparable cost\u2010effectiveness for adults aged \u2265\u200950 y undergoing major non\u2010cardiac surgery. Given clinical equipoise and equivalent economic outcomes, anaesthetic choice should continue to be guided by patient factors, clinician expertise and organisational context. Further research may be justified given the large population undergoing major surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70288","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:04:30Z","timestamp":1786521870000},"page":"1378-1385","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010effectiveness analysis of total intravenous vs. inhalation anaesthesia among adults aged \u2265\u200950 y undergoing major non\u2010cardiac surgery"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3042-7393","authenticated-orcid":false,"given":"Samuel","family":"Frempong","sequence":"first","affiliation":[{"name":"Centre of Health Economics University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Kandiyali","sequence":"additional","affiliation":[{"name":"Centre of Health Economics University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mason","sequence":"additional","affiliation":[{"name":"Centre of Health Economics University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Hiller","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Dunn","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Booth","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry 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UK"},{"name":"Division of Radiotherapy and Imaging The Institute of Cancer Research  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2950-4758","authenticated-orcid":false,"given":"Joyce","family":"Yeung","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the VITAL Trial 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