SEARCHSYSTEMATIC_REVIEWsurgery, clinical trial

systematic_review·surgery, clinical trial, systematic review, public health, family medicine·PMC10354976

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

BMC Medicine · 6 authors, 4 centres

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TL;DR

This systematic review of economic evaluations found some evidence that prehabilitation for elective surgery is cost-effective compared to usual care, but the evidence is limited by high risk of bias and methodological concerns in the included studies.

Full summary

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The review included 45 studies, with 25 completed economic evaluations (22 trial-based, 3 model-based). The primary outcome was cost-effectiveness from cost-utility analyses. The overall synthesis found that 64.0% (16/25) of economic evaluations found prehabilitation cost-effective. However, the methodological quality was generally low, with most trial-based evaluations judged to have a high risk of bias, primarily due to absent study protocols and inadequate confounding control. The conclusions suggest some evidence for cost-effectiveness but highlight the need for future evaluations with longer time horizons and more comprehensive perspectives.

STUDY TYPE

systematic_review

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surgery

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ORIGINAL PAPER

PMC10354976

Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations

BMC Medicine

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ABSTRACT

Abstract Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included. The primary outcome of the review was cost-effectiveness based on cost–utility analyses (CUAs). The risk of bias of trial-based EEs was assessed with the Cochrane risk of bias 2 tool and the ROBINS-I tool and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs’ results were synthesised narratively using vote counting based on direction of effect. Results We included 45 unique studies: 25 completed EEs and 20 ongoing studies. Of the completed EEs, 22 were trial-based and three model-based, corresponding to four CUAs, three cost-effectiveness analyses, two cost–benefit analyses, 12 cost–consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective, i.e. more effective and/or less costly than usual care. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%), cost-effectiveness was unclear, e.g. because prehabilitation was more effective and more costly, and in one EE prehabilitation was not cost-effective. Conclusions We found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective. Trial registration PROSPERO CRD42020182813. Supplementary Information The online version contains supplementary material available at 10.1186/s12916-023-02977-6. Keywords: Prehabilitation, Cost-effectiveness, Health economics, Systematic review, Evidence synthesis

CITATION EXPORT

Tanja Rombey, Helene Eckhardt, Jörn Kiselev et al.. Cost-effectiveness of prehabilitation prior to elective surgery: a systematic review of economic evaluations. BMC Medicine. (2023). https://doi.org/10.1186/s12916-023-02977-6

AUTHORS

6 · 4 CENTRES

Tanja Rombey, Helene Eckhardt, Jörn Kiselev, Julia Silzle, Tim Mathes, Wilm Quentin

1Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Berlin, 10623 Germany
2Department of Anesthesiology and Operative Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
4Department for Medical Statistics, University Medical Centre Goettingen, Goettingen, Germany