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Enhanced recovery protocols for pediatric colorectal surgery demonstrate cost-effectiveness: An economic analysis to
William Luo1, Ursula Adams2, Elizabeth Tracy2
1The University of North Carolina at Chapel Hill School of Medicine, Department of Surgery, 4001 Burnett-Womack Building CB #7050 Chapel Hill, NC 27599-7050 USA; WakeMed Health and Hospitals, 3000 New Bern Ave, Raleigh, NC 27610, USA.
Insights
Enhanced recovery pathways (ERPs) for pediatric colorectal surgery are more cost-effective and improve quality of life compared to standard care. These findings support wider implementation of ERPs in pediatric surgical centers.
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.
Background:
Enhanced recovery pathways (ERPs) after pediatric colorectal surgery have been shown to improve patient experience without compromising outcomes. ERPs for this population are also associated with reduced admission costs, but their economic impact in large populations is unclear. We present the first formal cost-effectiveness analysis of a pediatric colorectal surgery ERP from the payer perspective.
Methods:
We compared the cost-effectiveness of an ERP versus standard care in a pediatric patient requiring colorectal surgery without additional comorbid conditions, using a Markov microsimulation model to estimate the incremental cost-effectiveness ratio for each intervention. We sourced costs and health utilities from the peer-reviewed literature and transition-state probabilities from institutional primary data. We modeled our analysis from a US payer perspective over a 30-day time horizon and a willingness-to-pay ratio of $100,000/quality-adjusted life-year (QALY) gained by either intervention.
Results:
We simulated individual patient outcomes using published clinical outcomes for patients managed with and without an ERP (microsimulation). The statistical software evaluates the variability across 10,000 microsimulations and repeats the modeling 1,000 times (iterations). The software then reports the most likely outcome based on the summarized results. We found that our ERP was a cost-effective alternative to standard care in over 86% of iterations. On average, an admission with ERP costs $5,625 less and provides a health utility benefit of 0.002 QALY over 30 days compared to standard care. Our model was sensitive to the costs of acute-care hospital stays, celecoxib costs, and time to solid oral (PO) intake.
Conclusions:
In a first-of-its-kind cost-effectiveness analysis of ERPs for pediatric surgery, ERPs were both less costly and better for quality of life than standard care. These findings support the continued development and implementation of ERPs for pediatric patients requiring colorectal surgery, as well as the referral of such patients to centers with ERP programs.
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