Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada

• Published in: Canadian journal of surgery Vol. 63; no. 6; pp. E542 - E550
• Main Authors: Thanh, Nguyen, Nelson, Alison, Wang, Xiaoming, Faris, Peter, Wasylak, Tracy, Gramlich, Leah, Nelson, Gregg
• Format: Journal Article
• Language: English
• Published: Canada Joule Inc 01-12-2020
• Subjects: Aged; Alberta - epidemiology; Cost Savings - economics; Cost Savings - statistics & numerical data; Economic aspects; Enhanced Recovery After Surgery - standards; Evaluation; Female; Health Plan Implementation - economics; Humans; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Medical care; Medical care, Cost of; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Patient outcomes; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Postoperative care; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Practice Guidelines as Topic; Quality management; Surgical Procedures, Operative - adverse effects; Surgical Procedures, Operative - rehabilitation; Alberta; Canada
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.006720

Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term.
We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars.
The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated.
These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.