Financial Reporting & Audit Department, ESCP, Paris, France.
Department of Medical Informatics (S.I.M.M.E.R.), Nîmes University Hospital, Pl Pr Robert Debré, 30 029, Nîmes, France.
BMC Health Serv Res. 2021 Dec 14;21(1):1341. doi: 10.1186/s12913-021-07379-z.
Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program.
Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates.
The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million).
Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.
通过比较增强术后康复（ERAS）前后的患者护理成本，从医院和社会医疗保险计划的角度研究医疗经济影响。
这是一项针对 2019 年 3 月 1 日至 2019 年 12 月 31 日期间匹配数据的回顾性纵向研究。数据从法国前瞻性支付系统中提取。我们研究了 ERAS 中最常见的 12 个业务领域。主要结果是平均住院时间的缩短及其对生产成本和过剩产能的影响。我们还研究了对医院收入和社会医疗保险计划支出的影响。通过比较 ERAS 和非 ERAS 病例的住院时间，计算出医院可增加的住院天数。通过使用避免住院天数的平均数量和从国家成本研究中获得的住院费用来估计成本降低。最后，我们研究了在应用公共部门费率对成本进行标准化后，社会医疗保险计划额外费用的近似值。
ERAS 可使平均住院时间减少 1.45 天（95%CI 1.42-1.48），这意味着每位患者的医院成本降低 1060 欧元（95%CI 995-1125），总计 6500 万欧元（95%CI 61-69）。同时，社会医疗保险计划的额外费用可以保守地估计为 160 万欧元，其中 220 万欧元的增加部分被并发症后续住院的 60 万欧元成本节约所抵消。总体而言，对于研究范围内额外 ERAS 活动的每增加 1%，医院的边际成本降低可估计为 180 万欧元（95%CI 1.7 亿至 2.0 亿欧元）。
这些在经济收益方面令人信服的结果，与之前已知的患者临床获益相关，强烈支持扩大 ERAS 的应用。
