An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta
2016 (English)In: Canadian journal of surgery, ISSN 0008-428X, E-ISSN 1488-2310, Vol. 59, no 6, 6716Article in journal (Refereed) Published
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Place, publisher, year, edition, pages
Ottowa, Canada: Canadian Medical Association , 2016. Vol. 59, no 6, 6716
Health Care Service and Management, Health Policy and Services and Health Economy
IdentifiersURN: urn:nbn:se:oru:diva-52729DOI: 10.1503/cjs.006716PubMedID: 27669402OAI: oai:DiVA.org:oru-52729DiVA: diva2:1033072