Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Jan 21;8(1):e017782.
doi: 10.1136/bmjopen-2017-017782.

Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial

Esther V A Bouwsma  1   2   3 , Judith E Bosmans  3   4 , Johanna M van Dongen  3   4 , Hans A M Brölmann  1 , Johannes R Anema  2   3 , Judith A F Huirne  1   3
Affiliations
Randomized Controlled Trial

Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial

Esther V A Bouwsma et al. BMJ Open. .

Abstract

Objectives: To evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.

Design: Economic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.

Setting: Secondary care, nine hospitals in the Netherlands, 2011-2014.

Participants: 433 employed women aged 18-65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.

Intervention: The intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).

Main outcome measures: The primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.

Results: At 12 months, there were no statistically significant differences in total societal costs (€-647; 95% CI €-2116 to €753) and duration until RTW (-4.1; 95% CI -10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.

Conclusions: Considering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.

Trial registration number: NTR2933; Results.

Keywords: gynaecology; health economics; minimally invasive surgery; organisation of health services; telemedicine.

PubMed Disclaimer

Conflict of interest statement

Competing interests: JRA reports a chair in Insurance Medicine paid by the Dutch Social Security Agency, and he is a stockholder of Evalua. JAFH reports grants from Samsung, Gideon Richter and Celonova outside the submitted work. HAMB reports grants from Olympus and personal fees from Nordic Farma during the conduct of the study. JRA and JAFH are planning to set up a spin-off company concerning the implementation of a mobile application concerning the ikherstel intervention in the Netherlands.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
CE planes and CEA curves for RTW and QALYs. The CE planes indicate the uncertainty around the incremental cost-effectiveness ratio for RTW (A) and QALYs (C). The CEA curves indicate the probability of cost-effectiveness for different values (€) of willingness-to-pay per unit of effect gained for RTW (B) and QALYs (D). CE, cost-effectiveness; CEA, cost-effectiveness acceptability; QALY, quality-adjusted life year; RTW, return to work.
See this image and copyright information in PMC

References

    1. Cox H. Recovery from gynaecological day surgery: are we underestimating the process. Ambul Surg 2003;10:114–21. 10.1016/S0966-6532(03)00007-6 - DOI
    1. Horvath KJ. Postoperative recovery at home after ambulatory gynecologic laparoscopic surgery. J Perianesth Nurs 2003;18:324–34. 10.1016/S1089-9472(03)00181-3 - DOI - PubMed
    1. Gilmartin J. Contemporary day surgery: patients’ experience of discharge and recovery. J Clin Nurs 2007;16:1109–17. 10.1111/j.1365-2702.2007.01548.x - DOI - PubMed
    1. Evenson M, Payne D, Nygaard I. Recovery at home after major gynecologic surgery: how do our patients fare? Obstet Gynecol 2012;119:780–4. 10.1097/AOG.0b013e31824bb15e - DOI - PubMed
    1. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002;183:630–41. 10.1016/S0002-9610(02)00866-8 - DOI - PubMed

Publication types