bei Google ScholarTitelangaben
Rombey, Tanja ; Eckhardt, Helene ; Kiselev, Jörn ; Silzle, Julia ; Mathes, Tim ; Quentin, Wilm:
Cost-effectiveness of prehabilitation prior to elective surgery : a systematic review of economic evaluations.
In: BMC Medicine.
Bd. 21
(2023)
Heft 1
.
- 265.
ISSN 1741-7015
DOI: https://doi.org/10.1186/s12916-023-02977-6
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.
Weitere Angaben
| Publikationsform: | Artikel in einer Zeitschrift |
|---|---|
| Begutachteter Beitrag: | Ja |
| Keywords: | Cost-effectiveness; Evidence synthesis; Health economics; Prehabilitation; Systematic review |
| Institutionen der Universität: | Fakultäten > Rechts- und Wirtschaftswissenschaftliche Fakultät > Lehrstuhl Planetary and Public Health Profilfelder > Emerging Fields > Lebensmittel- und Gesundheitswissenschaften |
| Titel an der UBT entstanden: | Nein |
| Themengebiete aus DDC: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit |
| Eingestellt am: | 09 Apr 2024 10:34 |
| Letzte Änderung: | 09 Apr 2024 10:34 |
| URI: | https://eref.uni-bayreuth.de/id/eprint/89266 |