Cost-Effectiveness in Perioperative Care: Application of Markov Modeling to Pathways of Perioperative Care

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

Liver Transplantation ◽

10.1002/lt.22405 ◽

2011 ◽

Vol 17 (11) ◽

pp. 1247-1278 ◽

Cited By ~ 12

Author(s):

Karina Rando ◽

Claus U. Niemann ◽

Pilar Taura ◽

John Klinck

Keyword(s):

Liver Transplantation ◽

Cost Effectiveness ◽

Perioperative Care

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Cost-Effectiveness of Accelerated Perioperative Care and Rehabilitation After Total Hip and Knee Arthroplasty

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(09)79621-7 ◽

2010 ◽

Vol 2010 ◽

pp. 49-51

Author(s):

D.E. Feldman

Keyword(s):

Cost Effectiveness ◽

Knee Arthroplasty ◽

Perioperative Care ◽

Total Hip ◽

Hip And Knee Arthroplasty

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Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness?

Fertility and Sterility ◽

10.1016/j.fertnstert.2006.11.199 ◽

2007 ◽

Vol 88 (4) ◽

pp. 840-846 ◽

Cited By ~ 32

Author(s):

Michael H. Hsieh ◽

Maxwell V. Meng ◽

Paul J. Turek

Keyword(s):

Cost Effectiveness ◽

Female Partner ◽

Markov Modeling ◽

Vasectomy Reversal

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Cost-Effectiveness of Surgical Decompression for Space-Occupying Hemispheric Infarction

Stroke ◽

10.1161/strokeaha.113.002445 ◽

2013 ◽

Vol 44 (10) ◽

pp. 2923-2925 ◽

Cited By ~ 13

Author(s):

Jeannette Hofmeijer ◽

H. Bart van der Worp ◽

L. Jaap Kappelle ◽

Sara Eshuis ◽

Ale Algra ◽

...

Keyword(s):

Cost Effectiveness ◽

Confidence Interval ◽

Surgical Decompression ◽

Mean Difference ◽

Markov Modeling ◽

Middle Cerebral Artery Infarction ◽

Clinical Trial Registration ◽

Case Record ◽

Best Medical Treatment ◽

Hemispheric Infarction

Background and Purpose— Surgical decompression reduces mortality and increases the probability of a favorable functional outcome after space-occupying hemispheric infarction. Its cost-effectiveness is uncertain. Methods— We assessed clinical outcomes, costs, and cost-effectiveness for the first 3 years in patients who were randomized to surgical decompression or best medical treatment within 48 hours after symptom onset in the Hemicraniectomy After Middle Cerebral Artery Infarction With Life-Threatening Edema Trial (HAMLET). Data on medical consumption were derived from case record files, hospital charts, and general practitioners. We calculated costs per quality-adjusted life year (QALY). Uncertainty was assessed with bootstrapping. A Markov model was constructed to estimate costs and health outcomes after 3 years. Results— Of 39 patients enrolled within 48 hours, 21 were randomized to surgical decompression. After 3 years, 5 surgical (24%) and 14 medical patients (78%) had died. In the first 3 years after enrollment, operated patients had more QALYs than medically treated patients (mean difference, 1.0 QALY [95% confidence interval, 0.6–1.4]), but at higher costs (mean difference, €127 000 [95% confidence interval, 73 100–181 000]), indicating incremental costs of €127 000 per QALY gained. Ninety-eight percent of incremental cost-effectiveness ratios replicated by bootstrapping were >€80 000 per QALY gained. Markov modeling suggested costs of ≈€60 000 per QALY gained for a patient’s lifetime. Conclusions— Surgical decompression for space-occupying infarction results in an increase in QALYs, but at very high costs. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN94237756.

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PIH19 EXPANDED NEWBORN SCREENING IN TEXAS: A COST-EFFECTIVENESS ANALYSIS USING MARKOV MODELING

Value in Health ◽

10.1016/s1098-3015(10)73887-0 ◽

2009 ◽

Vol 12 (3) ◽

pp. A165

Author(s):

SK Tiwana ◽

KL Rascati

Keyword(s):

Cost Effectiveness ◽

Newborn Screening ◽

Cost Effectiveness Analysis ◽

Markov Modeling ◽

Effectiveness Analysis ◽

Expanded Newborn Screening

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Pipeline Endovascular Device vs Stent-Assisted Coiling in Small Unruptured Aneurysms: A Cost-Effectiveness Analysis

Neurosurgery ◽

10.1093/neuros/nyz130 ◽

2019 ◽

Vol 85 (6) ◽

pp. E1010-E1019 ◽

Cited By ~ 3

Author(s):

Ajay Malhotra ◽

Xiao Wu ◽

Waleed Brinjikji ◽

Timothy Miller ◽

Charles C Matouk ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Flow Diversion ◽

Sensitivity Analyses ◽

Base Case ◽

Markov Modeling ◽

Anterior Circulation ◽

Total Cost ◽

Unruptured Aneurysms ◽

Retreatment Rate

AbstractBACKGROUNDBoth stent-assisted coiling (SAC) and flow diversion with the Pipeline Embolization device (PED; Medtronic Inc) have been shown to be safe and clinically effective for treatment of small (<10 mm) unruptured aneurysms. However, the economic impact of these different techniques has not been established.OBJECTIVETo analyze the cost-effectiveness between stent-assisted coiling and flow diversion using PED, including procedural costs, long-term outcomes, and aneurysm recurrence.METHODSA decision-analytical study was performed with Markov modeling methods to simulate patients undergoing SAC or PED for treatment for unruptured aneurysms of sizes 5 and 7 mm. Input probabilities were derived from prior literature, and 1-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed.RESULTSIn base case calculation and PSA, PED was the dominant strategy for both the size groups, with and without consideration of indirect costs. One-way sensitivity analyses show that the conclusion remained robust when varying the retreatment rate of SAC from 0% to 50%, and only changes when the retreatment rate of PED > 49%. PED remained the more cost-effective strategy when the morbidity and mortality of PED increased by <55% and when those of SAC decreased by <37%. SAC only became cost-effective when the total cost of PED is >$73000 more expensive than the total cost of SAC.CONCLUSIONWith increasing use of PED for treatment of small unruptured anterior circulation aneurysms, our study indicates that PED is cost-effective relative to stent coiling irrespective of aneurysm size. This is due to lower aneurysm recurrence rate, as well as better health outcomes.

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