Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population

Abstract

Background:Enhanced recovery after surgery (ERAS) programs have been proved effective for enhancing the clinical healing rate and reducing hospitalization cost in most countries of the world. It's a multi-model approach that designed to optimize perioperative pathway, attenuate the surgical stress response, and decrease postoperative complications.Objective:The economic benefit from the application of ERAS to colorectal surgery has been demonstrated in China. However, such economic benefit of ERAS programs for hepatectomy hasn’t been clarified yet. This study was carried out to explore the clinical efficacy and cost effectiveness of ERAS in Chinese Han population after hepatectomy.Methods:ERAS program was implemented in our department for hepatectomy in December 2016. In total, 79 consecutive patients after hepatectomy were chosen as ERAS group (ERAS protocol) in coming half year while 121 consecutive patients after hepatectomy were chosen as Pre-ERAS group (traditional protocol) in past half year. The operation time, intraoperative blood loss, length of hospital stay (LOS), complication, readmission, and hospitalization cost of 2 groups were compared.Results:The LOS of ERAS group was 5.81 ± 1.79 days, significantly shorter than that of Pre-ERAS group (8.06 ± 3.40 d) (P = .000). The operation time was 168.03 ± 46.20 minutes for ERAS group and 175.41 ± 64.64 minutes for Pre-ERAS group respectively (P = .417). The intraoperative blood loss was 166.58 ± 194.13 mL (ERAS group) and 205.45 ± 279.63 mL (Pre-ERAS group) (P = .293). It should be noted that the hospitalization cost of ERAS group was 51556.18 ± 8926.05 Yuan (7835.05 ± 1355.45 US dollars), significantly less than that of Pre-ERAS group 60554.66 ± 15615.31 Yuan (9202.56 ± 2371.24 US dollars) (P = .000). The application of ERAS effectively saved 8998.48 Yuan (1367.51 US dollars) for each patient.Conclusions:ERAS implementation for hepatectomy surgery is safe and feasible for Chinese Han population. It eventually enhanced the clinical healing rate. The benefits from such programs include a reduction of the LOS, complication, and readmission rates. So each patient has access to better medical service. It effectively relieved the financial burden of patients. The benefits from such programs include a reduction of the hospitalization cost, especially in medication cost. So each patient can afford the diseases.

Combined robotic approach and enhanced recovery after surgery pathway for optimization of costs in patients undergoing proctectomy

“…The medicoeconomic impact of ERAS for rectal surgery is difficult to demonstrate. However, recent publications have underlined the cost benefit of enhanced recovery after hepatectomy or pancreatectomy. For colorectal surgery, a systematic review underlined the poor quality data currently available, but showed that ERAS was less costly and more effective than proctectomy alone.…”

Comprehensive economic evaluation of enhanced recovery after surgery in hepatectomy

“…Patients experienced a $1535.00 cost reduction after ERAS implementation. Previous studies have shown that ERAS effectively saved $1367.51 for each person [ 25 ]. Nelson et al’s economic evaluation of colorectal surgery found that the net cost savings attributable to ERAS ranged from $2806.00 to $5898.00 [ 26 ].…”

The economic benefits of enhanced recovery after surgery programmes

“…This inhospital cost-saving did not appear to result in higher costs to the community (26) on the basis of a health economics analysis which suggested the savings were also demonstrated outside hospital (27). Finally, in China, a group from Qingdao demonstrated a saving of 8,998.48 Yuan (US$1367.51) per patient undergoing hepatectomy surgery with their greatest cost saving arising from reduced medication requirements (28).…”