Cost-effectiveness of prehabilitation prior to elective surgery compared to usual preoperative care: protocol for a systematic review of economic evaluations

Rombey, Tanja; Eckhardt, Helene; Quentin, Wilm

doi:10.1136/bmjopen-2020-040262

Cited by 10 publications

(10 citation statements)

References 42 publications

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“…Cost remains one of the major barriers for the adoption of new healthcare systems. This theme was considered important by experts, ‘cost effectiveness of prehabilitation programmes’, and while there are proposed models for evaluating the cost effectiveness of prehabilitation programmes, 20 , 21 current literature is lacking. Other priorities identified, including ‘modes of delivery for prehabilitation’ and ‘prehabilitation during neoadjuvant therapies’, aligned with current trends in cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

et al. 2023

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Background Recently, the number of prehabilitation trials has increased significantly. The identification of key research priorities is vital in guiding future research directions. Thus, the aim of this collaborative study was to define key research priorities in prehabilitation for patients undergoing cancer surgery. Methods The Delphi methodology was implemented over three rounds of surveys distributed to prehabilitation experts from across multiple specialties, tumour streams and countries via a secure online platform. In the first round, participants were asked to provide baseline demographics and to identify five top prehabilitation research priorities. In successive rounds, participants were asked to rank research priorities on a 5-point Likert scale. Consensus was considered if > 70% of participants indicated agreement on each research priority. Results A total of 165 prehabilitation experts participated, including medical doctors, physiotherapists, dieticians, nurses, and academics across four continents. The first round identified 446 research priorities, collated within 75 unique research questions. Over two successive rounds, a list of 10 research priorities reached international consensus of importance. These included the efficacy of prehabilitation on varied postoperative outcomes, benefit to specific patient groups, ideal programme composition, cost efficacy, enhancing compliance and adherence, effect during neoadjuvant therapies, and modes of delivery. Conclusions This collaborative international study identified the top 10 research priorities in prehabilitation for patients undergoing cancer surgery. The identified priorities inform research strategies, provide future directions for prehabilitation research, support resource allocation and enhance the prehabilitation evidence base in cancer patients undergoing surgery.

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Section: Discussionmentioning

confidence: 99%

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

et al. 2023

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“…In den letzten Jahren hat die Prähabilitation zunehmend an Bedeutung gewonnen [4,10]. Die Prähabilitation als präoperative Vorbereitung des Patienten ist weltweit -insbesondere in der onkologischen, koronarangiographischen und orthopädischen Chirurgie -bekannt, findet allerdings (noch) keine systematische Anwendung [11].…”

Section: Einleitung Zielsetzung Und Fragestellungunclassified

Prähabilitation am Beispiel der vorderen Kreuzbandruptur – ist sie kosteneffektiv?

Richter,

Kwoka,

Lüske

et al. 2023

Gesundheitsökonomie & Qualitätsmanagement

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Zusammenfassung Hintergrund Verletzungen des Bewegungsapparats sind häufige Ereignisse im Sport. Bedürfen Verletzungen des Bewegungsapparats im Berufssportbereich einer Behandlung, sind neben dem Berufssportler (Patient) auch die Leistungserbringer (Ärzte, Therapeuten) und Kostenträger (im Berufs- bzw. Profisport: die Verwaltungs- Berufsgenossenschaft, VBG) am Verfahren beteiligt. Wird eine operative Therapie notwendig, stellt die präoperative körperliche Funktionsfähigkeit einen wichtigen prognostischen Faktor in Bezug auf den Genesungsprozess dar. In den letzten Jahren hat die Prähabilitation – d. h. die präoperative Verbesserung bzw. Verstärkung der Körperfunktionen zum Erhalt einer patientenindividuell optimalen Leistungs- und Funktionsfähigkeit nach einer geplanten Operation – zunehmend an Bedeutung gewonnen. Fragestellung und Zielsetzung In dieser Arbeit werden erstmals die Auswirkungen der Prähabilitation am Beispiel der vorderen Kreuzbandruptur aus Sicht aller Beteiligten dargestellt. Methodik Wir führten eine systematische Literaturrecherche in PubMed und Embase durch. Ergebnisse Von den initialen 1.862 Artikeln mussten 1.858 ausgeschlossen werden. Nur 2 Metaanalysen erfüllten die Einschlusskriterien. Der häufigste Ausschlussgrund war die ungenügende Qualität der Veröffentlichung. Die Studien zeigten, dass Patienten, die eine Prähabilitation erhielten, postoperativ eine höhere Muskelkraft und besseren Funktionszustand aufwiesen sowie schneller ihr vorheriges Leistungsniveau (Return to Play) erreichen konnten. Für die Physiotherapeuten ergab die Prähabilitation einen finanziellen Mehrwert (994.85 €), sofern die Vergütung der postoperativen Rehabilitation dadurch nicht gemindert wurde. Für den Unfallversicherungsträger bedeutete die kürzere Erholungsphase Kosteneinsparungen durch Verringerung des Verletztengeldes (14.933 € bei einer Einsparung von 8 Wochen), wenn dadurch das Risiko für erneute oder Folgeverletzungen nicht steigt. Diskussion Die Prähabilitation zeigte einen positiven Nutzen für alle Beteiligten. Sie dient dem Patienten dazu, die Funktionsfähigkeit zu verbessern und ggf. den Zeitraum bis zur Operation zu verkürzen. Für den Unfallversicherungsträger stehen den geringen Kosten der Prähabilitation Einsparmöglichkeiten gegenüber. Es ist wichtig, die in dieser Arbeit festgestellten positiven Auswirkungen der Prähabilitation in weiteren Arbeiten zur systematischen Anwendung der Prähabilitation im deutschen Gesundheitssystem zu prüfen. Fazit Bei der Prähabilitation handelt es sich um ein wissenschaftlich vernachlässigtes Forschungsthema. Die vorliegende Arbeit stellt (beispielhaft anhand der VKBR) erstmalig ihren Nutzen für alle Beteiligten (Versicherte bzw. Patienten, Physiotherapeuten und Versicherungsträger) dar. Die aktuelle Studienlage reicht nicht aus, um die systematische Anwendung der Prähabilitation im deutschen Gesundheitssystem zu empfehlen.

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“…All deaths will be identi ed at the end of the trial by querying the regional death registries. QALY was chosen for the health economic evaluation because a German valuation set is available (37,45) and the use of the outcome type in the evaluation of prehabilitation is internationally recognised, as a recent systematic review has shown (20).…”

Section: Choice and Measurement Of Health Outcomesmentioning

confidence: 99%

“…Overall, the available body of evidence often focuses on cancer (10,12,16,14,17,18) or orthopaedic surgeries (11,19), and is predominantly of low quality. Moreover, recent systematic reviews did not identify any cost-effectiveness studies of prehabilitation in frail surgical patients of advanced age (20,15).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Eckhardt,

Quentin,

Silzle

et al. 2023

Preprint

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Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery. Methods The planned health economic evaluation comprises cost-effectiveness, cost-utility, and cost-minimisation analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care. Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses. Discussion The health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population. Trial registration PRAEP-GO RCT: NCT04418271; economic evaluation: OSF (https://osf.io/swn79/ registration initiated on 29.06.2023).

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Cost-effectiveness of prehabilitation prior to elective surgery compared to usual preoperative care: protocol for a systematic review of economic evaluations

Cited by 10 publications

References 42 publications

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

Research Priorities in Prehabilitation for Patients Undergoing Cancer Surgery: An International Delphi Study

Prähabilitation am Beispiel der vorderen Kreuzbandruptur – ist sie kosteneffektiv?

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

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