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

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.

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.

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.

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.