Abstract
BackgroundOutpatient anesthesia clinics are well established in North America, Europe and Australia, but few economic evaluations have been published. The Perioperative Systems in Hong Kong are best described as a hybrid model of the new and old systems of surgical care. In this matched cohort study, we compared the costs and effects of an outpatient anesthesia clinic (OPAC) with the conventional system of admitting patients to the ward a day before surgery for their pre-anesthesia consultation. A second objective of the study was to determine the patient’s median Willingness To Pay (WTP) value for an OPAC.MethodsA total of 352 patients were matched (1:1) on their elective surgical procedure to either the clinic group or to the conventional group. The primary outcome was quality of recovery score and overall perioperative treatment cost (US$). To detect a difference in the joint cost-effect relationship between groups, a cost-effectiveness acceptability curve (CEAC) was drawn. A modified Poisson regression model was used to examine the factors associated with patients willing to pay more than the median WTP value for an OPAC.ResultsThe quality of recovery scores on the first day after surgery between the clinic and conventional groups were similar (mean difference, -0.1; 95% confidence interval (CI), -0.6 to 0.3; P = 0.57). Although the preoperative costs were less in the clinic group (mean difference, -$463, 95% CI, -$648 to -$278 per patient; P <0.001), the total perioperative cost was similar between groups (mean difference, -$172; 95% CI, -$684 to $340 per patient; P = 0.51). The CEAC showed that we could not be 95% confident that the clinic was cost-effective. Compared to the conventional group, clinic patients were three times more likely to prefer OPAC care (relative risk (RR) 2.75, 95% CI, 2.13 to 3.55; P <0.001) and pay more than the median WTP (US$13) for a clinic consultation (RR 3.27, 95% CI, 2.32 to 4.64; P <0.001).ConclusionsThere is uncertainty about the cost-effectiveness of an OPAC in the Hong Kong setting. Most clinic patients were willing to pay a small amount for an anesthesia clinic consultation.
Highlights
Outpatient anesthesia clinics are well established in North America, Europe and Australia, but few economic evaluations have been published
While it is intuitive that re-engineering of the surgical care system should result in a substantial reduction of healthcare costs from the benefits described, there is a paucity of economic evaluations [7]
Despite the apparent benefits associated with a Perioperative System, most Hong Kong patients are admitted to public hospitals a day before surgery and visited by an anesthesiologist for preoperative consultation on the ward
Summary
Outpatient anesthesia clinics are well established in North America, Europe and Australia, but few economic evaluations have been published. The Perioperative Systems in Hong Kong are best described as a hybrid model of the new and old systems of surgical care In this matched cohort study, we compared the costs and effects of an outpatient anesthesia clinic (OPAC) with the conventional system of admitting patients to the ward a day before surgery for their pre-anesthesia consultation. Compared to a conventional system of admitting patients at least a day before surgery, Perioperative Systems with outpatient anesthesia consultation clinics are well established in North America [1,2,3], Europe [4] and Australia [5,6]. The benefits of establishing an outpatient anesthesia clinic (OPAC) include increasing hospital efficiency by a rapid shift from inpatient to same day admission surgery, reduction in length of hospital stay, fewer cancellations of surgery and fewer preoperative investigations [1,2,4]. From 1 January to 31 December 2009, the percentage of elective operations performed as an outpatient surgery admission and same day admission surgery were 7% and 16%, respectively (unpublished observations)
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