title: Costs of relaparotomy on-demand versus planned relaparotomy in patients with severe peritonitis: an economic evaluation within a randomized controlled trial.
abstract: BACKGROUND
  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 >or=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 euro versus 83,450 euro per patient in the planned group; mean absolute difference, 17,682 euro; 95% CI, 5,062 euro to e29,004 euro). 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.
  
  
  BACKGROUND
  ISRCTN51729393.
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. bcopmeer@yahoo.co.uk
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Boer
authors.forename: Oddeke
authors.initials: O
authors.lastname: van Ruler
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Hein G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: Peter W
authors.initials: PW
authors.lastname: de Graaf
authors.forename: Bas
authors.initials: B
authors.lastname: Lamme
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gerhards
authors.forename: E Philip
authors.initials: EP
authors.lastname: Steller
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Mahler
authors.forename: Huug
authors.initials: H
authors.lastname: Obertop
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Patrick Mm
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Corianne Ajm
authors.initials: CA
authors.lastname: de Borgie
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis / Q000379:methods; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007813:Laparotomy / Q000191:economics*; D008875:Middle Aged; D009426:Netherlands; D010538:Peritonitis / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000191:economics*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult