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

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aut.relation.journalJournal of Physiotherapyen_NZ
aut.researcherReeve, Julie
dc.contributor.authorBoden, Ien_NZ
dc.contributor.authorRobertson, IKen_NZ
dc.contributor.authorNeil, Aen_NZ
dc.contributor.authorReeve, Jen_NZ
dc.contributor.authorPalmer, AJen_NZ
dc.contributor.authorSkinner, EHen_NZ
dc.contributor.authorBrowning, Len_NZ
dc.contributor.authorAnderson, Len_NZ
dc.contributor.authorHill, Cen_NZ
dc.contributor.authorStory, Den_NZ
dc.contributor.authorDenehy, Len_NZ
dc.date.accessioned2020-08-05T00:53:12Z
dc.date.available2020-08-05T00:53:12Z
dc.date.copyright2020-07en_NZ
dc.date.issued2020-07en_NZ
dc.description.abstractQuestion: 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.
dc.identifier.citationJournal of Physiotherapy (2020), DOI: 10.1016/j.jphys.2020.06.005
dc.identifier.doi10.1016/j.jphys.2020.06.005en_NZ
dc.identifier.issn1836-9553en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/13577
dc.languageenen_NZ
dc.publisherElsevier BVen_NZ
dc.relation.urihttps://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S183695532030059X?scrollTo=%23top
dc.rights© 2020 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/lice nses/by-nc-nd/4.0/).
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectCost-effectiveness analysis; Hospital costs; Physical therapists; Elective surgical procedures; Breathing exercises; Quality-adjusted life years
dc.titlePreoperative Physiotherapy Is Cost-effective for Preventing Pulmonary Complications After Major Abdominal Surgery: A Health Economic Analysis of a Multicentre Randomised Trialen_NZ
dc.typeJournal Article
pubs.elements-id383859
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Clinical Sciences
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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