Preoperative Physiotherapy Is Cost-effective for Preventing Pulmonary Complications After Major Abdominal Surgery: A Health Economic Analysis of a Multicentre Randomised Trial

Boden, I
Robertson, IK
Neil, A
Reeve, J
Palmer, AJ
Skinner, EH
Browning, L
Anderson, L
Hill, C
Story, D
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Journal Article
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Elsevier BV

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

Design: Costeffectiveness 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. Costutility 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.

Trial registration: ACTRN12613000664741.

Cost-effectiveness analysis; Hospital costs; Physical therapists; Elective surgical procedures; Breathing exercises; Quality-adjusted life years
Journal of Physiotherapy (2020), DOI: 10.1016/j.jphys.2020.06.005
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© 2020 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license ( nses/by-nc-nd/4.0/).