title: Cost-effectiveness of Enhanced Recovery Versus Conventional Perioperative Management for Colorectal Surgery.
abstract: OBJECTIVE
  To determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery.
  
  
  BACKGROUND
  ERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown.
  
  
  METHODS
  A multi-institutional prospective cohort cost-effectiveness analysis was performed. Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled. One center used an ERP, whereas the other did not. Postoperative outcomes were recorded up to 60 days. Total costs were reported in 2013 Canadian dollars. Effectiveness was measured using the SF-6D, a health utility measure validated for postoperative recovery. Uncertainty was expressed using bootstrapped estimates (10,000 repetitions).
  
  
  RESULTS
  A total of 180 patients were included (conventional care: n = 95; ERP: n = 95). There were no differences in patient characteristics except for a higher proportion of laparoscopy in the ERP group. Mean length of stay was shorter in the ERP group (6.5 vs 9.8 days; P = 0.017), but there were no differences in complications or readmissions. Patients in the ERP group returned to work quicker and had less caregiver burden. There was no difference in quality of life between the 2 groups. The cost of the ERP program was $153 per patient. Overall societal costs were lower in the ERP group (mean difference = -2985; 95% confidence interval, -5753 to -373). The ERP had a greater than 99% probability of cost-effectiveness. The results were insensitive to a range of assumptions and subgroups.
  
  
  CONCLUSIONS
  Enhanced recovery is cost-effective compared with conventional perioperative management for elective colorectal resection.
authors.affiliation: *Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada †Division of Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada ‡Department of Anaesthesia, McGill University Health Centre, Montreal, Quebec, Canada §Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.forename: Juan
authors.initials: J
authors.lastname: Mata
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Ghitulescu
authors.forename: Marylise
authors.initials: M
authors.lastname: Boutros
authors.forename: Patrick
authors.initials: P
authors.lastname: Charlebois
authors.forename: Barry
authors.initials: B
authors.lastname: Stein
authors.forename: A Sender
authors.initials: AS
authors.lastname: Liberman
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: Nancy
authors.initials: N
authors.lastname: Morin
authors.forename: Franco
authors.initials: F
authors.lastname: Carli
authors.forename: Eric
authors.initials: E
authors.lastname: Latimer
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D003082:Colectomy / Q000191:economics*; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*