A health economic model to assess the impact of prehabilitation on hospital cost savings in gastrointestinal cancer, modelled on English National Health Service tariff.

Abstract

6648 Background: Prehabilitation is increasingly being recognised as a high-priority intervention to improve physical and psychological health in cancer patients, prevent treatment-related functional decline and to reduce the incidence and severity of post-surgical complications. The aim of this study is to develop a health economic (HE) model to evaluate the impact of prehabilitation in patients undergoing gastrointestinal cancer surgery. Methods: The objective of the HE model is to estimate the impact of prehabilitation on reducing treatment costs. Data was extracted from systematic reviews and meta-analysis on the effects of prehabilitation in gastrointestinal cancer surgery to identify: i) treatment pathway, ii) prehabilitation components (nutrition/exercise/psychological intervention), and iii) effects on three study outcomes (length of hospital stay, reduction of post-operative complications, and reduced Intensive Care Unit (ICU) stay). The modelling study accounts for the number of hospital admissions and unit costs from NHS hospitals, including cost per bed-day from NHS Reference costs 2017-18 and complication costs and ICU cost from NHS Reference National Cost Schedule 2019-20. Double counting has been corrected to account for the compounded effects on length of stay and complications. The HE model considers the average effect of each study outcome and their confidence intervals. This provides a range of potential impact of prehabilitation in terms of cost reduction based on NHS tariff. Results: Patient weighted average cost savings from prehabilitation was £785, excluding ICU costs. Breakdown of cost savings include £178.6 from reduced length of hospital stay, £214.8 and £434.5 cost savings originating from reductions in minor and major complications, respectively (excluding ICU complication costs). ICU cost savings from prehabilitation were £1,620. For the NHS, based on 237,000 annual surgical procedures, this amounts up to £186,082,321 in cost savings, from a reduction in complications and 421,840 hospital days, and £52,761,227 from ICU stay. Conclusions: In addition to the impact on post-operative complications and hospital stay, this study has demonstrated that prehabilitation results in significant costs savings to healthcare systems. The cost savings are largely from a reduction in the incidence and severity of post-operative complications. The latter contributing to reduced ICU costs.