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Review
. 2021 Nov 13;20(1):245.
doi: 10.1186/s12939-021-01583-3.

Comprehensive economic evaluation of enhanced recovery after surgery in hepatectomy

Yihan Dong  1   2 , Yan Zhang  3   4 , Chengcheng Jin  1   5
Affiliations
Review

Comprehensive economic evaluation of enhanced recovery after surgery in hepatectomy

Yihan Dong et al. Int J Equity Health. .

Abstract

Background: Enhanced recovery after surgery (ERAS) is attracting extensive attention and being widely applied to reduce postoperative stress and accelerate recovery. However, the economic benefits of ERAS are less clarified at the social level. We aimed to assess the economic impact of ERAS in hepatectomy from the perspectives of patients, hospitals and society, as well as identify the approach to create the economic benefits of ERAS.

Methods: By combining the literature and national statistical data, the cost-effectiveness framework was clarified, and parameter values were determined. Cost-effectiveness analysis, cost-benefit analysis and cost-minimisation analysis were used to compare ERAS and conventional treatment from the perspectives of patients, hospitals and society. The capital flow diagram was used to analyse the change between them.

Results: ERAS significantly reduced the economic burden of disease on patients ($8935.02 vs $10,470.02). The hospital received an incremental benefit in ERAS (the incremental benefit cost ratio value is 1.09), and the total social cost was reduced ($5958.67 vs $6725.80). Capital flow diagram analysis demonstrated that the average daily cost per capita in the ERAS group increased ($669.51 vs $589.98), whereas the benefits depended on the reduction of hospital stay and productivity loss.

Conclusion: The mechanism by which ERAS works is to reduce the average length of stay, thereby reducing the economic burden and productivity loss on patients and promoting the hospital bed turnover rate. Therefore, ERAS should further focus on accelerating the rehabilitation process, and more economic support (such as subsidies) should be given to hospitals to carry out ERAS.

Keywords: Economic evaluation; Enhanced recovery after surgery; Hepatectomy; Multiple perspective; Social benefit.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Results of univariate sensitivity analysis (tornado analysis)
Fig. 3
Fig. 3
Analysis of changes in total social costs of ERAS group and control group
Fig. 4
Fig. 4
The capital flow diagram for cost variation analysis
See this image and copyright information in PMC

References

    1. Chinese Medical Association Surgery Branch, Chinese Medical Association Anesthesiology Branch Chinese expert consensus and path management guidelines for enhanced recovery after surgery (2018) Chin J Pract Surg. 2018;38(1):1–20.
    1. Jeong O, Kim HG. Implementation of enhanced recovery after surgery (ERAS) program in perioperative Management of Gastric Cancer Surgery: a Nationwide survey in Korea. J Gastric Cancer. 2019;19(1):72–82. doi: 10.5230/jgc.2019.19.e3. - DOI - PMC - PubMed
    1. Liu C, Qiao Q, Luo M, Wu W, Lu G. Application research progress on enhanced recovery after surgery. Chin Nurs Res. 2019;33(2):261–264.
    1. Zhang H. ERAS development helps "healthy China tour". China Hospital CEO. 2019;8:30–31.
    1. Li P, Song W, Cong W. The history of enhanced recovery after surgery. Electron J Gen Stomatol. 2019;6(28):153.

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