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Time-Driven Activity-Based Costing to Model Cost Utility of Enhanced Recovery after Surgery Pathways in Microvascular
Alexander F Mericli1, Thomas McHugh, Brittany Kruse
1From the Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX; Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX; Baker Institute for Public Policy, Rice University, Houston, TX.
Enhanced recovery after surgery (ERAS) programs are cost-effective for microvascular breast reconstruction. ERAS is less expensive and more effective than standard care, offering superior patient outcomes.
Area of Science:
- Oncology
- Plastic Surgery
- Health Economics
Background:
- Enhanced Recovery After Surgery (ERAS) programs are increasingly adopted in microvascular breast reconstruction.
- The cost-effectiveness of ERAS in this specific surgical context requires further investigation.
- This study aimed to evaluate the economic benefits of ERAS compared to standard care.
Purpose of the Study:
- To determine if an ERAS pathway for microvascular breast reconstruction is more cost-effective than the standard of care.
- To analyze the costs and clinical outcomes associated with ERAS in this patient population.
Main Methods:
- A decision-analytic model was developed to compare ERAS with standard care.
- Data on probabilities and utility scores were sourced from published literature.
- Time-driven activity-based costing was employed to estimate ERAS-related expenses.
- Sensitivity analyses were conducted to assess the reliability of the findings.
Main Results:
- ERAS was found to be dominant, demonstrating lower costs and improved effectiveness compared to standard care.
- The analysis indicated that ERAS remains cost-effective even with increased medication and personnel expenses.
- Sensitivity analyses showed ERAS becomes cost-ineffective only at a substantial increase in cost, suggesting its economic viability.
Conclusions:
- ERAS implementation in microvascular breast reconstruction is both cost-effective and associated with superior patient outcomes.
- The findings support the value and broader adoption of ERAS protocols in this surgical field.
- Time-driven activity-based costing offers valuable insights for quality improvement initiatives in surgical care.
