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Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial

Citation

Boden, I and Robertson, IK and Neil, A and Reeve, J and Palmer, AJ and Skinner, EH and Browning, L and Anderson, L and Hill, C and Story, D and Denehy, L, Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial, Journal of Physiotherapy, 66, (3) pp. 180-187. ISSN 1836-9553 (2020) [Refereed Article]


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Copyright Statement

2020 Australian Physiotherapy Association. Published by Elsevier B.V. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) http://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: doi:10.1016/j.jphys.2020.06.005

Abstract

Question: Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery?

Design: Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.

Participants: Four hundred and forty-one adults awaiting elective upper abdominal surgery attending pre-anaesthetic clinics at three public hospitals in Australia and New Zealand.

Interventions: The experimental group received an information booklet and a 30-minute face-to-face session, involving respiratory education and breathing exercise training, with a physiotherapist. The control group received the information booklet only.

Outcome measures: The probability of cost-effectiveness and incremental net benefits was estimated using bootstrapped incremental PPC and QALY cost-effectiveness ratios plotted on cost-effectiveness planes and associated probability curves through a range of willingness-to-pay amounts. Cost-effectiveness modelling utilised 21-day postoperative hospital cost audit data and QALYs estimated from Short Form-Six Domain health utilities and mortality to 12 months.

Results: Preoperative physiotherapy had 95% probability of being cost-effective with an incremental net benefit to participating hospitals of A$4,958 (95% CI 10 to 9,197) for each PPC prevented, given that the hospitals were willing to pay $45,000 to provide the service. Cost-utility for QALY gains was less certain. Sensitivity analyses strengthened cost-effectiveness findings. Improved cost-effectiveness and QALY gains were detected when experienced physiotherapists delivered the intervention.

Conclusions: Preoperative physiotherapy aimed at preventing PPCs was highly likely to be cost-effective from the hospitals' perspective. For each PPC prevented, preoperative physiotherapy is likely to cost the hospitals less than the costs estimated to treat a PPC after surgery. Potential QALY gains require confirmation.

Item Details

Item Type:Refereed Article
Keywords:cost-effectiveness analysis, hospital costs, physical therapists, elective surgical procedures, breathing exercises, quality-adjusted life years
Research Division:Health Sciences
Research Group:Allied health and rehabilitation science
Research Field:Physiotherapy
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Robertson, IK (Dr Iain Robertson)
UTAS Author:Neil, A (Associate Professor Amanda Neil)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:140036
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-07-22
Last Modified:2021-04-28
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