Recovery Program After Laparotomy More Cost-Effective Than Usual Care

Patients undergoing laparotomy for ovarian cancer who receive enhanced recovery experience a reduction in length of stay compared with standard care.
Patients undergoing laparotomy for ovarian cancer who receive enhanced recovery experience a reduction in length of stay compared with standard care.

An enhanced recovery program is more cost-effective than usual care in patients undergoing primary cytoreductive surgery for ovarian cancer, a study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology has shown.1

Previous research has demonstrated that patients undergoing laparotomy for ovarian cancer who receive enhanced recovery have a 63% reduction in length of stay compared with usual care; however, a recovery program increased perioperative medication use, leading to increased costs.

To evaluate the cost-effectiveness of an enhanced recovery program compared with usual care for this population, researchers developed a modified Markov state transition model using billing data.

Assuming that 20% of patients required bowel surgery, investigators estimated that the average costs for an enhanced recovery program is $13,177 vs $15,481 for usual care, a difference of $2304 in favor of the recovery program.

Results further showed that patients who entered the recovery program had a decreased length of stay of 2.2 days compared with those who received usual care. Because the enhanced recovery programs dominated usual care with respect to cost and clinical outcome, the investigators did not calculate an incremental cost-effectiveness ratio.

When researchers used a 50% rate of bowel surgery instead of a 20% rate, the enhanced recovery program resulted in an additional $1621 in cost savings per patient, suggesting that the recovery program becomes more cost-effective as surgical complexity increases. Cost savings per patient also increased if fewer patients received epidural analgesia.

The findings suggest that institutions should consider widespread implementation of enhanced recovery programs after primary cytoreductive surgery for patients with ovarian cancer.

Reference

1. Neff R, Wright JD, Cohn DE, Havrilesky LJ. Enhanced recovery after surgery (ERAS) for ovarian cancer: analyzing the cost effectiveness of a recovery program in primary cytoreductve surgery. Paper presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.
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