315 ERAS leads to fewer hospital costs in advanced ovarian cancer surgery: a secondary outcome of the PROFAST trial

Abstract

<h3>Introduction/Background*</h3> Enhanced recovery after surgery (ERAS) programs in advanced ovarian cancer (AOC) surgery have been developed in the last few years. The PROFAST randomized controlled trial showed that ERAS was associated with a decrease on length of stay and readmission. Here, we present the results of a secondary outcome, cost analysis, of the PROFAST trial. <h3>Methodology</h3> The PROFAST trial was a prospective, interventional randomized clinical trial that enrolled women undergoing surgery for either suspected or diagnosed advanced ovarian cancer, at a reference hospital in gynecologic oncology in Barcelona (Spain). Patients were treated following either an ERAS protocol or conventional management (CM) protocol. The primary outcome was to evaluate reduction in length of stay (LOS). One of the secondary outcomes was to perform cost analysis betweem both groups. Cost estimations were performed by two strategies: gross counting (cost of inpatient care, intensive care unit and surgery care), and microcosting (costs associated to image testing and laboratory). In both cases, costs were based on 2014 cost data. A sensitivity analysis of cost savings in different scenarios was performed. This trial was registered at ClinicalTrials.gov (NCT02172638). <h3>Result(s)*</h3> From June 2014 to March 2018, 110 women were recruited, of which eleven were excluded. The ERAS group comprised 50 patients, and the CM group, 49 patients. LOS. Although mean overall cost per patient was higher in ERAS vs CM (14347 € vs 12597€), ERAS cost distribution was skewed by two patients that accounted for 48% of total intensive care unit costs. Comparing median costs, ERAS costs were significantly lower than CM costs (7642€/patient vs 8594€/patient, P=.0275). Decrease in hospital readmission rates led to higher readmission costs in the CM group (Total costs 6126€ v 125725€, P=.028). Sensitivity analysis showed that, in the worst predicted scenario (median LOS corresponding to 12 days), 1146 €/patient would be saved if ERAS protocols were applied. <h3>Conclusion*</h3> Besides of achieving lower LOS and fewer readmission rates, implementation of an ERAS program in AOC surgery leads to valuable hospital savings. Therefore, ERAS should be the standard practice for AOC surgeries.