Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial
| Autor: | Amanda L. Neil, Iain K Robertson, Lesley Anderson, Andrew J. Palmer, Laura Browning, Cat Hill, Linda Denehy, David A Story, Elizabeth H Skinner, Julie Reeve, Ianthe Boden |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Lung Diseases
Male medicine.medical_specialty Cost-Benefit Analysis Psychological intervention Physical Therapy Sports Therapy and Rehabilitation Elective surgical procedures Preoperative care law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Quality of life Randomized controlled trial Breathing exercises law Abdomen Preoperative Care medicine Humans Single-Blind Method Quality-adjusted life years 030212 general & internal medicine health care economics and organizations Aged business.industry Cost-effectiveness analysis lcsh:RM1-950 Middle Aged Physical therapists Quality-adjusted life year lcsh:Therapeutics. Pharmacology Physical therapy Female Elective Surgical Procedure business Hospital costs 030217 neurology & neurosurgery Abdominal surgery |
| Zdroj: | Journal of Physiotherapy, Vol 66, Iss 3, Pp 180-187 (2020) |
| ISSN: | 1836-9553 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|