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Estimation of potential cost-savings related to the implementation of perioperative hemodynamic goal-directed therapy
Critical Care volume 17, Article number: P196 (2013)
Many studies have demonstrated the ability of perioperative hemodynamic goal-directed therapy (pGDT) to decrease postoperative morbidity in patients undergoing medium-to-high-risk surgery . As a result, pGDT may be a cost-saving strategy. Our goal was to provide an estimation of potential cost-savings based on recent literature.
The largest and most recent meta-analysis  on pGDT was used to estimate what could be the reduction of postoperative morbidity if pGDT was to be adopted. Costs related to the treatment of patients developing at least one (1+) postoperative complication were obtained from two recent US  and Swiss  publications. Potential cost-savings related to the adoption of pGDT were calculated according to the actual morbidity rate, assuming 0% pGDT use so far, and 100% compliance rate after implementation.
The 2011 meta-analysis  of 29 RCTs (4,805 patients) showed that pGDT is associated with a reduction in the rate of patients developing 1+ postoperative complications with odd ratios ranging between 0.35 and 0.55. Importantly, these odd ratios were not related to the morbidity rates. In the US publication , extra costs for treating patients with 1+ complication were $17,949. In the Swiss (CH) publication , they were $34,446. See Table 1
Depending on the pre-implementation morbidity rate, the degree of pGDT-induced morbidity reduction and the country, cost-savings ranged between $808 and $13,434 per patient. This large variability suggests that local/hospital estimations are desirable before starting pGDT implementation. These tailored evaluations would also allow more precise cost-saving estimations by taking into account the actual and expected pGDT compliance rates.
Hamilton MA, et al.: A 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
Boltz , et al.: Synergistic implications of multiple postoperative outcomes. Am J Med Qual 2012.
Vonlanthen R, et al.: The impact of complications on costs of major surgical procedures. Ann Surg 2011, 254: 907-913. 10.1097/SLA.0b013e31821d4a43
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Simon, T., Marx, G. Estimation of potential cost-savings related to the implementation of perioperative hemodynamic goal-directed therapy. Crit Care 17, P196 (2013). https://doi.org/10.1186/cc12134
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