Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial
| Autor: | Michael F. Gerhards, Patrick M.M. Bossuyt, Hein G. Gooszen, Peter W. de Graaf, Johannes B. Reitsma, Kimberly R. Boer, Corianne A. J. M. de Borgie, Bas Lamme, Marja A. Boermeester, Huug Obertop, Cecilia M Mahler, Brent C. Opmeer, E. Philip Steller, Dirk J. Gouma, Oddeke van Ruler |
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| Přispěvatelé: | APH - Amsterdam Public Health, Epidemiology and Data Science, Surgery, Other departments, AII - Amsterdam institute for Infection and Immunity, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Faculteit der Geneeskunde |
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Reoperation Comparative Effectiveness Research medicine.medical_specialty Cost Control Adolescent Total cost medicine.medical_treatment Peritonitis Critical Care and Intensive Care Medicine Severity of Illness Index law.invention Young Adult Randomized controlled trial law Surveys and Questionnaires Laparotomy Health care Severity of illness medicine Humans Young adult Intensive care medicine health care economics and organizations Quality of Health Care APACHE Aged Netherlands Aged 80 and over business.industry Research Health Care Costs Middle Aged medicine.disease United States Health Care Reform Economic evaluation Costs and Cost Analysis Commentary Health Resources business |
| Zdroj: | Critical care (London, England), 14(3). Springer Science + Business Media Critical Care Critical Care, 14(3). Springer Science + Business Media |
| ISSN: | 1364-8535 5172-9393 |
| DOI: | 10.1186/cc9032 |
| Popis: | Introduction Results of the first randomized trial comparing on-demand versus planned-relaparotomy strategy in patients with severe peritonitis (RELAP trial) indicated no clear differences in primary outcomes. We now report the full economic evaluation for this trial, including detailed methods, nonmedical costs, further differentiated cost calculations, and robustness of different assumptions in sensitivity analyses. Methods An economic evaluation was conducted from a societal perspective alongside a randomized controlled trial in 229 patients with severe secondary peritonitis and an acute physiology and chronic health evaluation (APACHE)-II score ≥11 from two academic and five regional teaching hospitals in the Netherlands. After the index laparotomy, patients were randomly allocated to an on-demand or a planned-relaparotomy strategy. Primary resource-utilization data were used to estimate mean total costs per patient during the index admission and after discharge until 1 year after the index operation. Overall differences in costs between the on-demand relaparotomy strategy and the planned strategy, as well as relative differences across several clinical subgroups, were evaluated. Results Costs were substantially lower in the on-demand group (mean, €65,768 versus €83,450 per patient in the planned group; mean absolute difference, €17,682; 95% CI, €5,062 to €29,004). Relative differences in mean total costs per patient (approximately 21%) were robust to various alternative assumptions. Planned relaparotomy consistently generated more costs across the whole range of different courses of disease (quick recovery and few resources used on one end of the spectrum; slow recovery and many resources used on the other end). This difference in costs between the two surgical strategies also did not vary significantly across several clinical subgroups. Conclusions The reduction in societal costs renders the on-demand strategy a more-efficient relaparotomy strategy in patients with severe peritonitis. These differences were found across the full range of healthcare resources as well as across patients with different courses of disease. Trial Registration ISRCTN51729393 |
| Databáze: | OpenAIRE |
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