Cost-effectiveness of a quality improvement bundle for emergency laparotomy

Area of Science:

• Health economics
• Quality improvement science
• Surgical patient outcomes

Background:

• The Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study demonstrated reduced mortality for emergency laparotomy patients using a care bundle.
• The economic impact of implementing the ELPQuiC bundle was previously undetermined.

Purpose of the Study:

• To evaluate the in-hospital and societal costs associated with implementing the ELPQuiC care bundle.
• To assess the cost-effectiveness of the ELPQuiC bundle from a societal perspective.

Main Methods:

• A before-after study design utilizing quality improvement methodology.
• Health economic modeling, including a short-term in-hospital cost model and a long-term societal decision tree model.
• Analysis of patient lifetime costs in euros.

Main Results:

• Initial ELPQuiC bundle implementation costs were estimated at €30,026.11 per hospital.
• In-hospital costs per patient were €14,817.24 for standard care versus €15,971.24 for the ELPQuiC bundle.
• Societal lifetime costs were €23,058.87 for standard care versus €19,102.37 for the ELPQuiC bundle, with cost savings of €11,410.38 per quality-adjusted life-year.

Conclusions:

• Implementing the ELPQuiC bundle leads to decreased mortality.
• While in-hospital costs increase, the ELPQuiC bundle results in reduced overall societal costs.
• The ELPQuiC bundle demonstrates cost-effectiveness through improved life expectancy and cost savings.