Abstract
BackgroundThe recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in‐hospital and societal costs of implementing the ELPQuiC bundle.MethodsThe ELPQuiC study employed a before–after approach using quality improvement methodology. To assess the costs and cost‐effectiveness of the bundle, two models were constructed: a short‐term model to assess in‐hospital costs and a long‐term model (societal decision tree) to evaluate the patient's lifetime costs (in euros).ResultsUsing health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64–40 784·06) per hospital. In‐hospital costs per patient were estimated at €14 817·24 for standard (non‐care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality‐adjusted life‐year saved.ConclusionImplementation of the ELPQuiC bundle is associated with lower mortality and higher in‐hospital costs but reduced societal costs.
Highlights
Emergency laparotomy has been shown to have a high mortality rate[1,2]
For the Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study, the quality improvement methodology used was based on the ‘model for improvement’[6]
The analysis was conducted in accordance with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines[17]
Summary
The Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) bundle, was conducted in four general district hospitals in England and used a six-point pathway[3]. For the ELPQuiC study, the quality improvement methodology used was based on the ‘model for improvement’[6] This included ongoing feedback and evaluation of data and performance throughout the study to assist implementation of the care bundle. The publication of this project followed the recommendations of the Standards for Quality Improvement Reporting Excellence (SQUIRE) statement[7]. The aim of this study was to assess the in-hospital and societal costs of implementing the ELPQuiC bundle. Conclusion: Implementation of the ELPQuiC bundle is associated with lower mortality and higher in-hospital costs but reduced societal costs
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