Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial

Table 3 Summary of sensitivity analyses: mean total costs and estimated absolute and relative differences between relaparotomy on demand and planned relaparotomy across alternative assumptions and calculation methods

			Mean	Mean		%
	Description	OD	PR	difference	95% CI^a	Difference
Analysis
Main	Main analysis (most probable assumptions)	65,768	83,450	17,682	(5,062 to 29,004)	21.2%
1	Percutaneous drainage procedures (reimbursement fee as opposed to AMC estimate)	65,754	83,428	17,674	(5,057 to 28,975)	21.2%
2	Ward-stay unit costs (weighted average of Academic and General hospitals)^b	62,938	81,016	18,078	(5,437 to 28,640)	22.3%
3	ICU-day unit costs (AMC top-down calculation instead of guideline)	70,694	90,980	20,286	(5,959 to 32,160)	22.3%
4	With ICU-day unit costs estimated for
	A United Kingdom	63,235	79,688	16,453	(4,788 to 28,439)	20.6%
	B Germany	61,541	77,172	15,631	(4,578 to 28,037)	20.3%
	C France	69,102	88,401	19,299	(5,371 to 29,721)	21.8%
	D Norway	77,225	100,465	23,240	(5,948 to 31,306)	23.1%
	E Austria	63,794	80,518	16,724	(4,851 to 28,560)	20.8%
	F Canada	58,960	73,338	14,378	(4,223 to 27,415)	19.6%
5	Exclude all costs of relaparatomy procedures	62,543	77,913	15,370	(3,018 to 25,395)	19.7%

^aBased on geometric means; ^bweighted by ratio of Academic and General hospital beds in the Netherlands (1:6). Explanation of different sensitivity analyses: (1) for percutaneous drainage procedure, AMC-unit costs estimates were replaced by reimbursement fees for this procedure. (2) To avoid the encountered cost differences where direct results from the differentiation between academic and nonacademic hospitals, a weighted average unit cost per hospital ward day was used. This average was weighted by the actual ratio of academic and nonacademic hospital beds in the Netherlands [29]. (3) We differentiated between unit costs of relaparotomies with and those without other surgical procedures (such as enterostomy (re)construction, abscess drainage, colon resection) instead of using the same all-in unit costs for all relaparotomies. (4a through f) To enhance generalizability of the results to other countries with publicly financed health care systems, Dutch reference prices for ICU days were replaced by unit costs estimated for the UK, Germany, France, Norway, Austria, and Canada, respectively [10, 19–23]. Additionally (5), we compared the total costs of the two strategies when disregarding the costs of relaparotomy procedures during the index admission because these differences were intrinsic to the strategy itself, as the planned strategy involved more procedures than did the on-demand strategy.

ISSN: 1364-8535