The online version of this article (doi:10.1186/1471-2253-14-40) contains supplementary material, which is available to authorized users.
JB Received lecturing fees and is member of the advisory board of the Edwards Lifesciences, all other authors declare NO competing interests.
JB designed the study, performed the calculations and drafted the manuscript; JZ and AS performed the data extraction and analysis; ICh and EK participated on the study design, helped to analyse the data and write the manuscript. All authors read and approved the final manuscript.
Perioperative goal directed therapy (GDT) can substantially improve the outcomes of high risk surgical patients as shown by many clinical studies. However, the approach needs initial investment and can increase the already very high staff workload. These economic imperatives may be at least partly responsible for weak adherence to the GDT concept. A few models are available for the evaluation of GDT cost-effectiveness, but studies of real economic data based on a recent clinical trial are lacking. In order to address this we have performed a retrospective analysis of the data from the “Intraoperative fluid optimization using stroke volume variation in high risk surgical patients” trial (ISRCTN95085011).
The health-care payers perspective was used in order to evaluate the perioperative hemodynamic optimization costs. Hospital invoices from all patients included in the trial were extracted. A direct comparison between the study (GDT, N = 60) and control (N = 60) groups was performed. A cost tree was constructed and major cost drivers evaluated.
The trial showed a significant improvement in clinical outcomes for GDT treated patients. The mean cost per patient were lower in the GDT group 2877 ± 2336€ vs. 3371 ± 3238€ in controls, but without reaching a statistical significance (p = 0.596). The mean cost of all items except for intraoperative monitoring and infusions were lower for GDT than control but due to the high variability they all failed to reach statistical significance. Those costs associated with clinical care (68 ± 177€ vs. 212 ± 593€; p = 0.023) and ward stay costs (213 ± 108€ vs. 349 ± 467€; p = 0.082) were the most important differences in favour of the GDT group.
Intraoperative fluid optimization with the use of stroke volume variation and Vigileo/FloTrac system showed not only a substantial improvement of morbidity, but was associated with an economic benefit. The cost-savings observed in the overall costs of postoperative care trend to offset the investment needed to run the GDT strategy and intraoperative monitoring.
Hamilton MA, Cecconi M, Rhodes A: A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesthesia & Analgesia. 2011, 112 (6): 1392-1402. 10.1213/ANE.0b013e3181eeaae5. CrossRef
Mowatt G, Houston G, Hernndez R, De Verteuil R, Fraser C, Cuthbertson B, Vale L: Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients. Health Technol Assess (Rockv). 2009, 13 (7): 1-1.
Briggs A, Gray A: The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 1998, 3 (4): 233-245. PubMed
- Cost analysis of the stroke volume variation guided perioperative hemodynamic optimization – an economic evaluation of the SVVOPT trial results
- BioMed Central
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