Accepted for/Published in: JMIR Perioperative Medicine
Date Submitted: Oct 29, 2019
Date Accepted: Jan 10, 2021
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Enhanced recovery programme for open liver resection improves hospital costs and two-year survival without increasing costs in primary care.
ABSTRACT
Background:
The clinical benefits of enhanced recovery programmes [ERPs] have been extensively researched, but few studies have evaluated the cost-effectiveness of programmes. This study follows on from a previous randomised controlled trial.
Objective:
To evaluate the cost-effectiveness and impaxct upon long-term survival of an enhanced recovery after surgery programme for patients undergoing open liver resection surgery.
Methods:
A decision-analytic model was used to compare the study endpoint Enhanced Recovery versus standard care provided to patient with open liver resection. Outcomes obtained were costs per life-years gained. Resource use and costs were estimated from the National Health System perspective. The Decision tree and Markov Model were constructed using the original results and augmented by external data of published clinical trials.
Results:
Patients receiving Enhanced Recovery had an average life expectancy of 6.9 years versus 6.1 years in the standard group. Costs were 9538.279 GBP for ERP and 14793.05 GBP for standard treatment. This results in a cost-effectiveness ratio of -6748.33 GBP/QALY. Patients required fewer visits to their GP (p=0.006) and required less help at home with day to day activities (p=0.036). Survival at 2 years was 91.3% (ERP) vs 71.3% for the standard care group (p=0.03).
Conclusions:
Enhanced Recovery for open liver resection can improve medium-term survival and is cost effective for both hospital and community settings. Clinical Trial: ISRCTN03274575 - http://www.controlled-trials.com
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