SPU Main Site  |  Past & Future Meetings
Society For Pediatric Urology

Back to 2022 Abstracts


ENHANCED RECOVERY AFTER SURGERY A COST-EFFECTIVE PROGRAMME FOR PEDIATRIC BLADDER RECONSTRUCTIVE SURGERY
Ganesh Vythilingam, MBBS ,MRCS, Master Pediatric Surgery , PhD, Roger Idi, MBBS, Master Surgery, Katie Cleary, BsC Nursing, Kevin Cao, MBBS,MRCS,MSc, Neetu Kumar, MBBS,FRCS Pediatric Surgery, Imran Mushtaq, MB, ChB,FRCS (Glasg),FRCS (Paed),MD, Abraham Cherian, MBBS MSR,FMS Gen Surgery,FRCS Pediatric Surgery, David De Beer, BSc (Zoology), MB ChB, FRCA, Navroop Johal, MB BCh ,MRCS, FRCS Pediatric Surgery, PhD..
Great Ormond Street Hospital, London, United Kingdom.

BACKGROUND
ERAS is a multidimensional approach that has been shown to improve patients care, reduce complication and is cost effective in adult surgery. In 2018 we set up a multidisciplinary team to develop an ERAS protocol for paediatric patients undergoing bladder reconstruction. In this study we sought to evaluate the cost effectiveness by measuring healthcare expenditures against the quality of life (QoL), of this pathway and compared them to a matched historical group.
METHODS
This is a prospective, single-centre, trial of an ERAS protocol from February 2019. Costings data were derived from episodic institutional expenses from financial years 2008 to 2022. Cost calculations were generated from the electronic medical record system. Cost items were assigned into 7 domains to identify areas of savings. Costs were inflated at 8% yearly to bring to current values. QoL values were generated through direct interview with patients at least 6-months following recovery in a non-clinical setting utilising the EQ-5D-5L (EuroQoL) healthcare questionnaire and paediatric proxy versions. Scores in five domains: mobility, self-care, activity, pain and anxiety/depression, were computed into a single index metric of quality of life, or happiness score, based on UK population indices (Devlin et al. 2018), to enable generation of quality-adjusted life years (QALYs) , and consequent cost-effectiveness figures.
RESULTS


Table 1: Cost breakdowns as per different cost categories
13 patients underwent our ERAS protocol for ileocystoplasty and compared against 21 patients who underwent legacy management. Average length of stay was 6 days (4-9 days range) compared to 11 days for legacy management (6-29 days). Total cost of ileocystoplasty under the ERAS protocol was 20,078 versus 26,147 for legacy care. This amounted to a total savings of 6069. Average index scores for QoL under ERAS were 0.86 (0.48-1.0) and 0.91 for legacy care (0.6-1.0, p = 0.27, not significant unpaired t-test). ERAS generated 58.5 QALYs, at a cost-effectiveness of 362 per QALY, whilst legacy care generated 63 QALYs, at a cost-effectiveness of 427.
CONCLUSION
Adherence to the ERAS protocol led to a reduced length of stay and this translated to a reduction in the average unit cost per patient. The ERAS programme for paediatric ileocystoplasty is a highly cost-effective programme for this major reconstructive operation generating a comparable level of quality-of-life measure at 6 months of post-operative recovery.
Reference
Valuing health-related quality of life: An EQ-5D-5L value set for England
Nancy Devlin et al
Health Economics 2018 Jan;27(1):7-22.


Back to 2022 Abstracts