The cost-effectiveness of preoperative optimisation of high risk surgical patients

Aims

This study aimed to determine the cost-effectiveness of a London National Health Service Hospital Trust providing preoptimisation with intravenous fluids, oxygen, and inotropes to High Risk Surgical Patients with the aim of reducing postoperative complications.

Design

A cost-effectiveness study.

Method

The cost of usual care for a 5 month cohort (n = 40) of High Risk Surgical patients was calculated by using the standard Health Resource Group costs provided by the NHS Executive which gives average costs for Hospital Stay based on procedures and treatment. Intensive care bed days were added at a local rate (£1072) multiplied by number of days spent in ITU. Group average costs were calculated for those who suffered postoperative complications (n = 13, £7751) and those that did not (n = 27, £2983). The cost of preoptimisation was estimated by including preoperative and postoperative costs such as Intensive care and HDU bed usage, equipment, and the time of a Consultant Anaesthetist (total cost per patient = £1328). Predicted reductions of morbidity were taken from a published randomised controlled trials. Sensitivity analysis was performed on a range of costs and effects.

Results

Results showed that preoptimisation is cost-effective as it dominates in comparison to usual care. Sensitivity analysis also showed that the treatment remained cost-effective even if the intervention gives a reduced effect.

Conclusion

Preoptimisation would be cost-effective for the London NHS Trust as it would reduce cost of hospitalisation care by reducing the recovery period of High Risk Surgical Patients.