Article Text

Cost-effectiveness of prehabilitation prior to elective surgery compared to usual preoperative care: protocol for a systematic review of economic evaluations
  1. Tanja Rombey,
  2. Helene Eckhardt,
  3. Wilm Quentin
  1. Department of Health Care Management, Technische Universität Berlin, Berlin, Berlin, Germany
  1. Correspondence to Ms Tanja Rombey; tanja.rombey{at}


Introduction Preoperative functional capacity is an important predictor of postoperative outcomes. Prehabilitation aims to optimise patients’ functional capacity before surgery to improve postoperative outcomes. As prolonged hospital stay and postoperative complications present an avoidable use of healthcare resources, prehabilitation might also save costs.

The aim of this systematic review is to investigate the cost-effectiveness of prehabilitation programmes for patients awaiting elective surgery compared with usual preoperative care. The results will be useful to inform decisions about the implementation of prehabilitation programmes and the design of future economic evaluations of prehabilitation programmes.

Methods and analysis We will search PubMed, Embase, the Centre for Reviews and Dissemination Database, the WHO International Clinical Trials Registry Platform and for full or partial economic evaluations of preoperative prehabilitation programmes conducted in any population compared with usual preoperative care. Studies will be included regardless of the type, design and perspective of the economic evaluation, and their publication year, language or status. Initial searches were performed between 30 April and 4 May 2020.

Study selection, data extraction and assessment of the included studies’ risk of bias and methodological quality will initially be performed by two independent reviewers and, if agreement was sufficiently high, by one reviewer. We will extract data regarding the included studies’ basic characteristics, economic evaluation methods and cost-effectiveness results.

A narrative synthesis will be performed. The primary endpoint will be cost-effectiveness based on cost–utility analyses. We will discuss heterogeneity between the studies and assess the risk of publication bias. The certainty of the evidence will be determined using the Grading of Recommendations, Assessment, Development and Evaluation approach.

Ethics and dissemination Ethics approval is not required as the systematic review will not involve human participants. We plan to present our findings at scientific conferences, pass them on to relevant stakeholder organisations and publish them in a peer-reviewed journal.

PROSPERO registration number CRD42020182813

  • health economics
  • rehabilitation medicine
  • surgery

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Supplementary materials


  • Contributors TR and WQ conceptualised the review. TR drafted the protocol. HE and WQ revised the protocol. All authors were involved in the conception of the protocol, approved the final version of the manuscript to be published and agree to be accountable for all aspects of the planned systematic review.

  • Funding The systematic review is part of a larger project which is supported by the Innovation Fund coordinated by the Innovation Committee of the Federal Joint Committee in Germany (Innovationsausschuss beim Gemeinsamen Bundesausschuss (G-BA)), grant number 01NVF18024. Furthermore, we acknowledge support by the Open Access Publication Fund of TU Berlin who covered the Article Processing Charge for this protocol.

  • Disclaimer The funders had no role in developing the protocol.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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