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Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-4170-6451
Örebro University, School of Health Sciences. University Health Care Research Centre.ORCID iD: 0000-0001-8433-6529
Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
Örebro University, School of Health Sciences.ORCID iD: 0000-0001-7575-6745
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2017 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed) Published
Abstract [en]

Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

Clinical trial registration:NCT02492191

Place, publisher, year, edition, pages
Oxford University Press, 2017. Vol. 119, no 5, p. 1039-1046
Keywords [en]
Ambulatory surgery, cost effectiveness, mobile applications, postoperative period
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-61954DOI: 10.1093/bja/aex332ISI: 000413642900027PubMedID: 29077819Scopus ID: 2-s2.0-85034731856OAI: oai:DiVA.org:oru-61954DiVA, id: diva2:1152658
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-4765Swedish Research Council, 2015-02273Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2018-05-22Bibliographically approved
In thesis
1. e-Assessed follow-up of postoperative recovery: developement, evaluation and patient experiences
Open this publication in new window or tab >>e-Assessed follow-up of postoperative recovery: developement, evaluation and patient experiences
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The majority of all surgeries are performed as day surgery. After discharge, patients are expected to take responsibility for their postoperative recovery themselves. Recovery Assessment by Phone Points (RAPP) is an e-assessment developed for assessing and providing follow-up on postoperative recovery, which includes the Swedish web-version of the Quality of Recovery questionnaire (SwQoR). It also enables the patient to get in contact with the day surgery unit. The overall aim of this thesis was to further develop and evaluate a systematic follow-up of postoperative recovery using a mobile app in adult persons undergoing day surgery, as well as to describe their experiences of postoperative recovery when using the mobile app. Study I: This study included three steps. Equivalence testing between the paper and app versions of the SwQoR showed agreement (n=69). The feasibility and acceptability evaluation showed that participants (n=63) were positive towards using a mobile phone application during postoperative recovery. Content validity of the SwQoR reduced the original 31 items to 24. Studies II and III: A multicentre, two-group, parallel, single-blind randomized controlled trial including 997 participants was conducted to investigate the effect of e-assessment on postoperative recovery (II) and cost-effectiveness (III) in a RAPP group compared with a control group. The RAPP group reported significantly better quality of postoperative recovery on postoperative days 7 and 14 compared with the control group. Moreover, RAPP may be cost-effective as it provides low-cost care. Study IV: Explored experience of postoperative recovery in participants using a mobile phone app during their postoperative recovery. Qualitative inductive semi-structured interviews (n=18) were performed. Findings showed that feeling safe is important during postoperative recovery. This feeling can be created by patients themselves, but sufficient support and information from health care and next of kin is needed. Overall, this thesis showed positive results for RAPP, suggesting that RAPP is a solution that may benefit patients after day surgery.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 182
Keywords
Ambulatory surgery, cost-effectiveness, eHealth, mobile applications, postoperative recovery, qualitative research, randomised controlled trial
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-65776 (URN)978-91-7529-249-6 (ISBN)
Public defence
2018-06-15, Örebro universitet, Forumhuset, Hörsal F, Fakultetsgatan 1, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-03-14 Created: 2018-03-14 Last updated: 2018-05-28Bibliographically approved

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Dahlberg, KarunaPhilipsson, AnnaHagberg, LarsJaensson, MariaHälleberg Nyman, MariaNilsson, Ulrica

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British Journal of Anaesthesia
Anesthesiology and Intensive Care

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