Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries

A body of scientific studies has shown that early extubation is safe and cost-effective in a large number of liver transplant (LT) recipients including pediatric patients. However, fast-track practices are not universally accepted, and debate still lingers about whether these interventions are safe and serve the patients’ best interest. In this article, we focus on reasons why physicians still have a persistent, although diminishing, reluctance to adopt fast-track protocols. We stress the importance of collection/analysis of perioperative data, adoption of a consensus-based standardized protocol for perioperative care, and formation of LT anesthesia focused teams and leadership. We conclude that the practice of early extubation and fast-tracking after LT surgery could help improve anesthesia performance, safety, and cost-effectiveness.

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Faculty Opinions recommendation of Anesthesia for liver transplantation in US academic centers: institutional structure and perioperative care.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717297828.792652837 ◽

2012 ◽

Author(s):

John Augoustides ◽

Elizabeth Valentine

Keyword(s):

Liver Transplantation ◽

Perioperative Care ◽

Institutional Structure

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Cost Effectiveness of Immunosuppression Withdrawal after Liver Transplantation

Transplantation Journal ◽

10.1097/01.tp.0000542729.11771.9a ◽

2018 ◽

Vol 102 ◽

pp. S121

Author(s):

Tommaso Maria Manzia ◽

Cristina Angelico ◽

Samuele Iesari ◽

Kevin Ackenine ◽

Jan Lerut ◽

...

Keyword(s):

Liver Transplantation ◽

Cost Effectiveness

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Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial

BMJ Open ◽

10.1136/bmjopen-2017-017782 ◽

2018 ◽

Vol 8 (1) ◽

pp. e017782

Author(s):

Esther V A Bouwsma ◽

Judith E Bosmans ◽

Johanna M van Dongen ◽

Hans A M Brölmann ◽

Johannes R Anema ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Usual Care ◽

Perioperative Care ◽

Cost Effective ◽

Stepped Wedge ◽

Gynaecological Surgery ◽

Care Programme ◽

Societal Costs ◽

Cluster Randomised

ObjectivesTo evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.DesignEconomic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.SettingSecondary care, nine hospitals in the Netherlands, 2011–2014.Participants433 employed women aged 18–65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.InterventionThe intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).Main outcome measuresThe primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.ResultsAt 12 months, there were no statistically significant differences in total societal costs (€−647; 95% CI €−2116 to €753) and duration until RTW (−4.1; 95% CI −10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.ConclusionsConsidering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.Trial registration numberNTR2933; Results.

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