Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis

Abstract

Objective To assess the potential cost-effectiveness of prehabilitation in medically frail patients undergoing surgery for epithelial ovarian cancer (EOC). Methods We created a cost-effectiveness model evaluating the impact of prehabilitation on a cohort of medically frail women undergoing primary surgical intervention for EOC. Cost was assessed from the healthcare system perspective via (1) inpatient charges from 2018–2019 institutional Diagnostic Related Grouping data for surgeries with and without major complications; (2) nursing facility costs from published market surveys. Major complication and non-home discharge rates were estimated from the literature. Based on published pilot studies, prehabilitation was determined to decrease these rates. Incremental cost-effectiveness ratio for cost per life year saved utilized a willingness-to-pay threshold of $100,000/life year. Modeling was performed with TreeAge software. Results In a cohort of 4,415 women, prehabilitation would cost $371.1 Million (M) versus $404.9 M for usual care, a cost saving of $33.8 M/year. Cost of care per patient with prehabilitation was $84,053; usual care was $91,713. When analyzed for cost-effectiveness, usual care was dominated by prehabilitation, indicating prehabilitation was associated with both increased effectiveness and decreased cost compared with usual care. Sensitivity analysis showed prehabilitation was more cost effective up to a cost of intervention of $9,418/patient. Conclusion Prehabilitation appears to be a cost-saving method to decrease healthcare system costs via two improved outcomes: lower complication rates and decreased care facility requirements. It represents a novel strategy to optimize healthcare efficiency. Prospective studies should be performed to better characterize these interventions in medically frail patients with EOC.

Feasibility of a Multimodal Prehabilitation Programme in Patients Undergoing Cytoreductive Surgery for Advanced Ovarian Cancer: A Pilot Study

“…In our study, the hospital length of stay was significantly lower in the prehabilitation cohort, irrespective of the fact that both groups received perioperative care in accordance with ERAS guidelines. Hospital length of stay seems to be an appropriate indicator of the effect of prehabilitation, because it reflects the extent to which patients have recovered baseline physical functioning; moreover, shorter stays likely result in lower hospital costs [ 31 ]. Nevertheless, other studies have reported discrepant results regarding the effects of prehabilitation on hospital stay [ 13 , 32 , 33 ].…”

Physical Effects, Safety and Feasibility of Prehabilitation in Patients Awaiting Orthotopic Liver Transplantation, a Systematic Review

“…One can imagine that the supervision and provision of a personalized training program for this frail population requires professional health-care workers as physiotherapists and dieticians. However, since previous studies showed cost-effectiveness for prehabilitation in patients undergoing abdominal surgery (46), we think that investing in personalized training programs for this specifically frail population could be beneficial. However, the effects of physical training in this patient population are still not decisive, and objectively measured effects of structured training programs on days of hospitalization, presence of complications and functional evolution after transplantation are scarce.…”

Cost Analysis of a Digital Multimodal Cancer Prehabilitation

“…A large study with 4415 women with ovarian cancer estimated that the cost of care with prehabilitation per patient was USD 84,053 while the cost of usual care was USD 91,713. Sensitivity analysis showed that prehabilitation was more cost-effective at USD 9418/patient [ 19 ].…”