Ebm C, Aggarwal G, Huddart S, Cecconi M, Quiney N
Department of Anaesthesia and General Management Wiener Privatklinik (WPK) Vienna Vienna Austria.
Department of Anaesthesia Royal Surrey County Hospital Guildford UK.
BJS Open. 2018 Jun 14;2(4):262-269. doi: 10.1002/bjs5.62. eCollection 2018 Aug.
The recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in-hospital and societal costs of implementing the ELPQuiC bundle.
The ELPQuiC study employed a before-after approach using quality improvement methodology. To assess the costs and cost-effectiveness of the bundle, two models were constructed: a short-term model to assess in-hospital costs and a long-term model (societal decision tree) to evaluate the patient's lifetime costs (in euros).
Using health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64-40 784·06) per hospital. In-hospital costs per patient were estimated at €14 817·24 for standard (non-care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality-adjusted life-year saved.
Implementation of the ELPQuiC bundle is associated with lower mortality and higher in-hospital costs but reduced societal costs.
近期的急诊剖腹手术路径质量改进护理（ELPQuiC）研究表明，使用特定的护理包可降低急诊剖腹手术患者的死亡率。然而，实施ELPQuiC护理包的成本仍不清楚。本研究的目的是评估实施ELPQuiC护理包的住院成本和社会成本。
ELPQuiC研究采用前后对照方法并运用质量改进方法。为评估护理包的成本和成本效益，构建了两个模型：一个短期模型用于评估住院成本，一个长期模型（社会决策树）用于评估患者的终身成本（以欧元计）。
利用健康经济模型和从ELPQuiC研究中收集的数据，估计每家医院最初实施ELPQuiC护理包的成本为30026.11欧元（范围为1794.64 - 40784.06欧元）。标准（非护理包）治疗的每位患者住院成本估计为14817.24欧元，而ELPQuiC护理包治疗的为15971.24欧元。从社会角度看，标准组患者的终身成本为23058.87欧元，接受ELPQuiC护理包的患者为19102.37欧元。接受ELPQuiC护理包治疗的患者预期寿命增加4个月，与每挽救一个质量调整生命年节省11410.38欧元的成本相关。
实施ELPQuiC护理包与较低的死亡率和较高的住院成本相关，但社会成本降低。
