Economic evaluation comparing From Home To Operation same day admission and preoperative admission one day prior to the surgery process: a randomized, controlled trial of laparoscopic cholecystectomy.
OBJECTIVE
A novel preoperative procedure From Home To Operation (FHTO) seeks to combat increasing operation and infection rates. This is the first prospective randomized controlled trial (RCT) comparing the cost-effectiveness and cost-utility of FHTO and conventional ward procedures for standardized Laparoscopic Cholecystectomy (LC).


METHODS
During 12/2004-7/2005, 47 patients with symptomatic gallstones were randomized to receive LC in the FHTO (28 patients) or in a conventional manner (19 patients) in a Finnish hospital setting. The 15D quality of life tool was administered at the baseline and 1 month after.


METHODS
A stochastic approach over a month interval for hospital costs, length of postoperative stay, infection rate and Quality-Adjusted Life Years (QALY) was employed.


RESULTS
Baseline group characteristics were similar. The mean health care costs with FHTO (1695 EUR) were significantly lower (p < 0.001) than in the conventional arm (2234 EUR). The number of patients discharged on the first postoperative day was 27 (96.4%) and 15 (78.9%) with two (7.1%) infections in the FHTO and four (21.1%) in the conventional arm. A difference in QALYs gained (0.0174; p = 0.030) favouring FHTO was observed. According to a cost-effectiveness acceptability curve, the probability of FHTO being cost-effective was 99%. The results were robust to probabilistic sensitivity analyses.


CONCLUSIONS
FHTO can introduce substantial cost savings and have a positive impact on both clinical measures and quality of life. Studies with larger numbers of patients are needed to assess whether conventional ward procedure can be a source of infections, which can be avoided with FHTO.


BACKGROUND
ICJME-qualified registry of the Hospital District of Helsinki and Uusimaa (number 217849).
Keränen
J
J
Faculty of Medicine, University of Kuopio, Finland.
Soini
E J O
EJ
Ryynänen
O-P
OP
Hietaniemi
K
K
Keränen
U
U
D017081:Cholecystectomy, Laparoscopic / Q000191:economics*; D005387:Finland; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010343:Patient Admission; D010351:Patient Discharge; D011300:Preoperative Care; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years