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Cost efficiency of ERAS protocols versus conventional method in urologic oncology: a systematic review of economic
Arief Yanda1, Jufriady Ismy2, Muhammad Puteh Mauny2
1Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh.
Background:
Urologic oncology procedures are resource-intensive and contribute substantially to healthcare expenditure. Enhanced Recovery After Surgery (ERAS) protocols have been proposed to optimize perioperative care, reduce morbidity, and improve economic efficiency. However, the cost impact of ERAS compared with conventional perioperative management in urologic oncology has not been comprehensively synthesized.
Methods:
This systematic review followed PRISMA guidelines. Database searches were performed using PubMed/MEDLINE, Scopus, Cochrane Library, SpringerLink, and Google Scholar for studies published between 2015 and 2025. Search terms included: "ERAS" AND "urologic oncology" AND "cost efficiency" OR "cost savings". Eligible studies including adult patients who underwent oncologic urologic surgery, comparing the ERAS versus the non-ERAS protocol, and reporting cost outcomes. Data were extracted for study characteristics, ERAS components, and cost results. Risk of bias was assessed using the Newcastle-Ottawa Scale.
Results:
A total of 472 articles were identified, and seven studies (n = 1,247 patients) met the inclusion criteria. ERAS shows costsaving effects in six studies (85.7%) and cost neutrality in one (14.3%), with no evidence of financial harm. Reported savings ranged from USD 1,444 to USD 4,488 per patient in U.S. cohorts and up to 7,353 Y in Chinese cohorts. Cost reductions were primarily attributed to shorter length of stay, reduced complication- related expenditure, and improved perioperative resource utilization. NOS scores ranged from 6 to 7, indicating satisfactory to good quality.
Conclusions:
ERAS protocols provide consistent economic advantages over conventional care in urologic oncology, demonstrating cost savings or cost neutrality across diverse procedures and healthcare systems. Standardization of ERAS components, harmonized cost-reporting methods, and prospective cost-effectiveness analyses are needed to support policy adoption and establish ERAS as a cost-efficient component of value-based urologic cancer care.
