Nguyen Thanh1, Alison Nelson1, Xiaoming Wang1, Peter Faris1, Tracy Wasylak1, Leah Gramlich1, Gregg Nelson1. 1. From the Strategic Clinical Networks, Alberta Health Services, Edmonton and Calgary, Alta. (Thanh, Wasylak); the Surgery Strategic Clinical Network, Alberta Health Services, Calgary, Alta. (A. Nelson); Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Edmonton and Calgary, Alta. (Wang, Faris); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gramlich); and the Section of Gynecologic Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alta. (G. Nelson).
Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.
Background: Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.
Authors: Krishna K Varadhan; Keith R Neal; Cornelius H C Dejong; Kenneth C H Fearon; Olle Ljungqvist; Dileep N Lobo Journal: Clin Nutr Date: 2010-01-29 Impact factor: 7.324
Authors: Lawrence Lee; Juan Mata; Gabriela A Ghitulescu; Marylise Boutros; Patrick Charlebois; Barry Stein; A Sender Liberman; Gerald M Fried; Nancy Morin; Franco Carli; Eric Latimer; Liane S Feldman Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: S P Bisch; T Wells; L Gramlich; P Faris; X Wang; D T Tran; N X Thanh; S Glaze; P Chu; P Ghatage; J Nation; V Capstick; H Steed; J Sabourin; G Nelson Journal: Gynecol Oncol Date: 2018-08-09 Impact factor: 5.482
Authors: Gregg Nelson; Xiaoming Wang; Alison Nelson; Peter Faris; Laura Lagendyk; Tracy Wasylak; Oliver F Bathe; David Bigam; Erin Bruce; W Donald Buie; Michael Chong; Adrian Fairey; M Eric Hyndman; Anthony MacLean; Michael McCall; Sophia Pin; Haili Wang; Leah Gramlich Journal: JAMA Netw Open Date: 2021-08-02