Cost analysis of the enhanced recovery after surgery protocol applied in advanced ovarian cancer: A secondary outcome of the PROFAST trial. Issue 12 (December 2022)

• Record Type: Journal Article
• Authors: Sánchez-Iglesias, J.L.; Bebia, V.; Gimenez, E.; Aller, M.B.; Bradbury, M.; Pérez-Benavente, M.A.; Gil-Moreno, A.; Cossio-Gil, Y.
• Is Part Of: European journal of surgical oncology. Volume 48:Issue 12(2022)
• Page Start: 2545
• Page End: 2550
• Publication Date: 2022-12
• Subjects: Enhanced recovery after surgery -- Avanced ovarian cancer surgery; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2022.07.013
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: A randomised trial implementing Enhanced Recovery After Surgery (ERAS) for high complexity advanced ovarian cancer (AOC) surgery (PROFAST) demonstrated a reduction of median length of stay and hospital readmissions when compared to patients managed conventionally. One secondary objective was to determine if an ERAS pathway in the perioperative management of advanced ovarian cancer patients led to cost savings. Material and methods: Secondary objective of a prospective randomised trial of patients with suspected or diagnosed advanced ovarian cancer allocated to conventional or ERAS perioperative management, carried out at a referral centre from June 2014 to March 2018. Treatment was determined by a computer-generated random allocation system. Methods: Gross counting was employed to estimate the cost of hospitalisation in wards, intensive care unit (ICU) and surgical care, while micro-costing was used to obtain image and laboratory test costs. Mean costs between trial arms were considered. Sensitivity analyses were performed. Results: Ninety-nine patients (n = 50 ERAS group, n = 49 Conventional group) were included. Mean costs per patient were 10, 719€ in the ERAS group and 11, 028€ in the conventional group, leading to an average saving of 309€ per patient. These results were based on 96 patients, excluding 3 extreme outliers mainly related with very high ICU costs. Savings, which were significant for hospital ward costs (−33% total; 759€ per patient in first hospitalisation, and 914€ per partient/day of readmission) were found as robust in the sensitivity analysis. Conclusions: Implementation of an ERAS pathway leads to cost savings when compared to conventional management after AOC surgery. Highlights: - Implementation of an ERAS pathway for advanced ovarian cancer surgery leads to cost savings when compared to conventional perioperative management. - Mean costs per patient were 10, 719€ in the ERAS group and 11, 028€ in the conventional group, leading to an average saving of 309€ per patient. - For hospital ward costs, savings constituted −33% of the total; 759€ per patient in first hospitalisation and 914€ per partient/day of readmission.