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Cost-effectiveness analysis of stroke volume variation guided perioperative hemodynamic optimization
Critical Care volume 17, Article number: P191 (2013)
Perioperative goal-directed therapy (pGDT) can substantially improve the outcome of high-risk surgical patients . But the approach needs an initial investment and increases the staff workload. Economic factors might participate in the weak adherence to the pGDT concept. Some model studies support pGDT cost-effectiveness, but real economic data based on a recent clinical trial are lacking. We performed an economic analysis of hemodynamic optimization using the stroke volume variation trial  in order to elucidate this issue.
The hospital care invoices of all 120 patients included in the trial were retrospectively extracted. Due to the nature of the data we have adopted the healthcare payer's perspective. We performed a comparison of induced costs between the Vigileo (n = 60) and Control (n = 60) groups and constructed a cost tree using the study group and complications occurrence as distributive parameters. The incremental cost-effectiveness ratio per complication avoided was calculated and, finally, different reimbursing categories were assessed as potential cost drivers.
A decreased rate (18 vs. 35 patients) and number of complications (34 vs. 78) were observed in the original trials Vigileo group. The mean cost of intervened patient was lower (€2,877 ± 2,336 vs. €3,371 ± 3,238; P = 0.38). According to the cost-tree analysis, patients with complications (n = 53; 44%) consumed significantly more resources (€235,623; 63%). A gain of €634 per avoided complications confirms that the lower complications rate was the most important cost driver. Both the clinical care for patients costs (€505 vs. 912; P = 0.04) and ward stay costs (€244 vs. 402; P = 0.03) were decreased by the intervention. On the contrary, the intervention increased anaesthesia costs (€880 vs. 688; P = 0.001).
Intraoperative fluid optimization with the use of stroke volume variation and the Vigileo/FloTrac system showed not only a substantial improvement of morbidity, but was also associated with an economic benefit. This observed benefit highly exceed the increased monitoring costs in our trial.
Hamilton MA, et al.: Systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg 2011, 112: 1392-1402. 10.1213/ANE.0b013e3181eeaae5
Benes J, et al.: Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 2010, 14: R118. 10.1186/cc9070
The study was supported by the MSM0021620819 and the Charles University Research Fund (project number P36).
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Benes, J., Zatloukal, J., Simanova, A. et al. Cost-effectiveness analysis of stroke volume variation guided perioperative hemodynamic optimization. Crit Care 17, P191 (2013). https://doi.org/10.1186/cc12129
- Stroke Volume Variation
- Cost Driver
- Hemodynamic Optimization
- Ward Stay
- Staff Workload