Prehabilitation worth it? A theoretical algorithmic for the cost-effectiveness of a multimodal prehabilitation program for complex abdominal surgery

Abstract

Presenter: Laura van Wijk MD | University Medical Center Groningen, the Netherlands Background: Emerging evidence emphasizes that prehabilitation has beneficial effects on postoperative outcomes after complex abdominal surgery (ref), especially in high-risk populations. Evidence that prehabilitation also has financial benefits, may result in accelerated implementation of prehabilitation programs. This study aims to develop an universally applicable algorithmic model for calculating the return on investment (ROI) of a multimodal prehabilitation program. Methods: The model consists of six modifiable patient related risk factors for postoperative complications and its associated preoperative interventions for optimization. These six patient related risk factors include: low physical fitness, impaired nutritional status, the presence of iron deficiency anaemia, frailty, and intoxications (alcohol use and smoking behavior). The cost-effectiveness was determined with four main statistics: the incidence of the patient related risk factor, the average costs of the intervention to optimize the patient with respect to the risk factor, the success rate of the intervention and the weighted importance of the intervention that contributes to risk reduction based on a Delphi method. These four main statistics and the current data on complication rates, the expected maximal increase and decrease in complication rate related to the presence or absence of all risk factors, and the hospital admission costs were brought together into a scenario tree. Data of these four main statistics, complication rates and hospital expenses were obtained from the Dutch Institute for Clinical Auditing combined with a literature search. Pancreatic surgery was used as an example to fill in the model and calculate the potential financial benefits when a multimodal prehabilitation program would be implemented. Results: The average hospital expenses per patient who underwent pancreatic surgery without interventions to optimize risk factors, is €32.953. The scenario analysis showed that, if all prehabilitation interventions were implemented, hospital expenses could be reduced to €30.511, thus a profit per patient of €2.442. The total cost of implementing the interventions was €1.576 per patient. The return-on-investment (ROI) was calculated as (€2.442/€1.576)*100, resulting in a ROI of 1,55. Conclusion: This study developed an universally applicable algorithm for calculating the costs and benefits of a multimodal prehabilitation program for complex abdominal surgery. Additionally, the model showed that a multimodal prehabilitation program for pancreatic cancer surgery is financially beneficial with a ROI of 1.55.