Cost-Effectiveness of Day Surgery With Remote Patient Monitoring for Acute Cholecystitis: Economic Modeling Study
John Paul Kuwornu1, David Brain1, Kheng-Seong Ng2
1Australian Centre for Health Services Innovation (AusHSI), School of Public Health and Social Work, Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Level 7, 88 Musk Avenue, Kelvin Grove QLD, Brisbane, Queensland, 4059, Australia, +61 7 3138 6115.
Background:
Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored.
Objective:
This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis.
Methods:
Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years [QALYs]), and health care costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Health care costs were estimated from the Australian health care funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses.
Results:
The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model versus 1.5 days for the acute day-surgery model) and lowering net health care costs by a mean of AU $1,416 (US $935) per case over the 1-year time horizon. There was no meaningful difference in QALYs between the care models. These results remained robust in both deterministic and probabilistic sensitivity analyses.
Conclusions:
An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the health care system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.
