Thanh Nguyen X., Chuck Anderson W., Wasylak Tracy, Lawrence Jeannette, Faris Peter, Ljungqvist Olle, Nelson Gregg, Gramlich Leah M.
From the Institute of Health Economics, Edmonton, Alta. (Thanh, Chuck); Alberta Health Services, Calgary, Alta. (Wasylak, Lawrence, Faris); the Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden (Ljungqvist); the Department of Oncology, University of Calgary, Calgary, Alta. (Nelson); the Department of Medicine, University of Alberta, Edmonton, Alta. (Gramlich).
Can J Surg. 2016 Dec 1;59(6):415-421. doi: 10.1503/cjs.006716.
In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites.
We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique.
We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000–$3 391 000), or $1768 (range $920–$2619) per patient. The probability for the program to be cost-saving was 73%–83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4–$5.1) in return.
The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites.
2013年2月，艾伯塔省医疗服务部门设立了一项术后加速康复（ERAS）实施计划，将ERAS协会的结直肠手术指南应用于该省6个开展超过75%的结直肠手术的地点（初始阶段）。我们对该计划进行了经济评估，不仅要确定其成本效益，还要为ERAS推广至其他手术方案和地点提供策略依据。
我们通过使用多水平负二项回归比较ERAS实施前后的组，评估了ERAS对出院后30天内患者医疗服务利用情况（HSU；住院时间[LOS]、再入院、急诊就诊、全科医生和专科医生就诊）的影响。我们使用决策分析建模技术估计了ERAS实施后患者的净医疗成本/节省以及与这些影响相关的投资回报率（ROI）。
我们的分析纳入了331例ERAS实施前患者和1295例ERAS实施后患者。ERAS与除专科医生就诊外的所有HSU结局的减少相关。然而，只有主要住院时间的减少具有统计学意义。估计医疗系统净节省为229万美元（范围为119.1万美元至339.1万美元），或每位患者1768美元（范围为920美元至2619美元）。该计划节省成本的概率为73%至83%。就投资回报率而言，每投入1美元的ERAS将带来3.8美元（范围为2.4美元至5.1美元）的回报。
艾伯塔省结直肠手术ERAS实施的初始阶段具有成本节约效果。当ERAS推广至其他手术方案并覆盖更多地点时，总节省可能会更加可观。
