Enhanced recovery protocols for pediatric colorectal surgery demonstrate cost-effectiveness: An economic analysis to...

Area of Science:

• Pediatric Surgery
• Health Economics
• Clinical Pathways

Background:

• Enhanced Recovery Pathways (ERPs) improve patient experience and outcomes in pediatric colorectal surgery.
• While ERPs reduce admission costs, their broader economic impact remains unclear.
• This study presents the first cost-effectiveness analysis of a pediatric colorectal surgery ERP from a payer perspective.

Purpose of the Study:

• To compare the cost-effectiveness of an ERP versus standard care for pediatric colorectal surgery.
• To evaluate the economic impact of ERPs in a large patient population from a US payer perspective.
• To determine if ERPs are a cost-effective intervention within a defined willingness-to-pay threshold.

Main Methods:

• A Markov microsimulation model was used to compare ERPs and standard care.
• Data on costs, health utilities, and transition probabilities were sourced from literature and institutional data.
• The analysis was conducted from a US payer perspective over a 30-day horizon with a $100,000/QALY willingness-to-pay threshold.

Main Results:

• The ERP was found to be cost-effective in over 86% of model iterations.
• On average, ERP admissions cost $5,625 less and yielded 0.002 QALY benefit over 30 days compared to standard care.
• Model sensitivity analysis identified acute-care hospital stay costs, celecoxib costs, and time to oral intake as key factors.

Conclusions:

• ERPs for pediatric colorectal surgery are both less costly and improve quality of life compared to standard care.
• These findings support the continued development and implementation of ERPs for pediatric surgical patients.
• Referral of pediatric colorectal surgery patients to centers with established ERP programs is recommended.