Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trialReport as inadecuate




Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 14:R97

First Online: 27 May 2010Received: 11 December 2009Revised: 09 April 2010Accepted: 27 May 2010

Abstract

IntroductionResults 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.

MethodsAn 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.

ResultsCosts 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.

ConclusionsThe 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 RegistrationISRCTN51729393

AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation

CRFclinical report form

CEAcost-effectiveness analysis

CMAcost-minimization analysis

CTcomputed tomography

FFPfresh frozen plasma

HR-QoLhealth-related quality of life

ICUintensive care unit

ODon demand relaparotomy

PCDpercutaneous drainage

PRplanned relaparotomy

RELAP trialrandomized controlled trial comparing relaparotomy on demand with planned relaparotomy

USultrasound

US$United States dollar

95% CI95% confidence interval.

Electronic supplementary materialThe online version of this article doi:10.1186-cc9032 contains supplementary material, which is available to authorized users.

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Author: Brent C Opmeer - Kimberly R Boer - Oddeke van Ruler - Johannes B Reitsma - Hein G Gooszen - Peter W de Graaf - Bas Lam

Source: https://link.springer.com/







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