Ianthe Boden1, Iain K Robertson2, Amanda Neil3, Julie Reeve4, Andrew J Palmer5, Elizabeth H Skinner6, Laura Browning7, Lesley Anderson8, Cat Hill9, David Story10, Linda Denehy11. 1. Department of Physiotherapy, Launceston General Hospital, Launceston, Australia; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. Electronic address: ianthe.boden@ths.tas.gov.au. 2. School of Health Sciences, University of Tasmania, Launceston, Australia. 3. Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. 4. School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand. 5. Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 6. Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia. 7. Department of Physiotherapy, The University of Melbourne, Melbourne, Australia; Directorate of Community Integration, Allied Health and Service Planning, Western Health, Melbourne, Australia. 8. Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand. 9. Physiotherapy Department, North West Regional Hospital, Burnie, Australia. 10. Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. 11. Head Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia; Allied Health Research lead, Peter McCallum Cancer Centre, Melbourne, Australia.
Abstract
QUESTION: Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery? DESIGN: Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Four hundred and forty-one adults awaiting elective upper abdominal surgery attending pre-anaesthetic clinics at three public hospitals in Australia and New Zealand. INTERVENTIONS: The experimental group received an information booklet and a 30-minute face-to-face session, involving respiratory education and breathing exercise training, with a physiotherapist. The control group received the information booklet only. OUTCOME MEASURES: The probability of cost-effectiveness and incremental net benefits was estimated using bootstrapped incremental PPC and QALY cost-effectiveness ratios plotted on cost-effectiveness planes and associated probability curves through a range of willingness-to-pay amounts. Cost-effectiveness modelling utilised 21-day postoperative hospital cost audit data and QALYs estimated from Short Form-Six Domain health utilities and mortality to 12 months. RESULTS:Preoperative physiotherapy had 95% probability of being cost-effective with an incremental net benefit to participating hospitals of A$4,958 (95% CI 10 to 9,197) for each PPC prevented, given that the hospitals were willing to pay $45,000 to provide the service. Cost-utility for QALY gains was less certain. Sensitivity analyses strengthened cost-effectiveness findings. Improved cost-effectiveness and QALY gains were detected when experienced physiotherapists delivered the intervention. CONCLUSIONS:Preoperative physiotherapy aimed at preventing PPCs was highly likely to be cost-effective from the hospitals' perspective. For each PPC prevented, preoperative physiotherapy is likely to cost the hospitals less than the costs estimated to treat a PPC after surgery. Potential QALY gains require confirmation. TRIAL REGISTRATION: ACTRN12613000664741.
RCT Entities:
QUESTION: Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery? DESIGN: Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Four hundred and forty-one adults awaiting elective upper abdominal surgery attending pre-anaesthetic clinics at three public hospitals in Australia and New Zealand. INTERVENTIONS: The experimental group received an information booklet and a 30-minute face-to-face session, involving respiratory education and breathing exercise training, with a physiotherapist. The control group received the information booklet only. OUTCOME MEASURES: The probability of cost-effectiveness and incremental net benefits was estimated using bootstrapped incremental PPC and QALY cost-effectiveness ratios plotted on cost-effectiveness planes and associated probability curves through a range of willingness-to-pay amounts. Cost-effectiveness modelling utilised 21-day postoperative hospital cost audit data and QALYs estimated from Short Form-Six Domain health utilities and mortality to 12 months. RESULTS: Preoperative physiotherapy had 95% probability of being cost-effective with an incremental net benefit to participating hospitals of A$4,958 (95% CI 10 to 9,197) for each PPC prevented, given that the hospitals were willing to pay $45,000 to provide the service. Cost-utility for QALY gains was less certain. Sensitivity analyses strengthened cost-effectiveness findings. Improved cost-effectiveness and QALY gains were detected when experienced physiotherapists delivered the intervention. CONCLUSIONS: Preoperative physiotherapy aimed at preventing PPCs was highly likely to be cost-effective from the hospitals' perspective. For each PPC prevented, preoperative physiotherapy is likely to cost the hospitals less than the costs estimated to treat a PPC after surgery. Potential QALY gains require confirmation. TRIAL REGISTRATION: ACTRN12613000664741.
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