title: Cost analysis of the stroke volume variation guided perioperative hemodynamic optimization - an economic evaluation of the SVVOPT trial results.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ISRCTN95085011.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Benes
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Zatloukal
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
authors.forename: Alena
authors.initials: A
authors.lastname: Simanova
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Chytra
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
authors.forename: Eduard
authors.initials: E
authors.lastname: Kasal
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005440:Fluid Therapy / Q000191:economics / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care / Q000191:economics / Q000379:methods; D016343:Monitoring, Intraoperative / Q000191:economics / Q000379:methods; D019990:Perioperative Care / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume
keywords: Cost-effectiveness; Fluid optimization; Hemodynamic optimization