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Abstract
Objectives To evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.
Design Economic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.
Setting Secondary care, nine hospitals in the Netherlands, 2011–2014.
Participants 433 employed women aged 18–65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.
Intervention The intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).
Main outcome measures The primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.
Results At 12 months, there were no statistically significant differences in total societal costs (€−647; 95% CI €−2116 to €753) and duration until RTW (−4.1; 95% CI −10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.
Conclusions Considering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.
Trial registration number NTR2933; Results.
- gynaecology
- telemedicine
- minimally invasive surgery
- health economics
- organisation of health services
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Footnotes
Contributors All authors made substantial contributions to this study and the article. EVAB, HAMB, JRA and JAFH participated in the design and/or execution of the study, the interpretation of data and the drafting and/or revision of the article. JEB and JMvD were involved in the statistical data analyses, interpretation of the data and revision of the article. All authors approved the final version of the manuscript. EVAB and JAFH are the study guarantors.
Funding This study is funded by the Netherlands Organisation for Scientific Research and Development (ZonMw grants 171102015 and 92003590).
Competing interests JRA reports a chair in Insurance Medicine paid by the Dutch Social Security Agency, and he is a stockholder of Evalua. JAFH reports grants from Samsung, Gideon Richter and Celonova outside the submitted work. HAMB reports grants from Olympus and personal fees from Nordic Farma during the conduct of the study. JRA and JAFH are planning to set up a spin-off company concerning the implementation of a mobile application concerning the ikherstel intervention in the Netherlands.
Patient consent Obtained.
Ethics approval The study protocol was approved by the Institutional Review Board of the VU University Medical Centre (16 May 2011, no 2011/142) and by the medical ethics committees of Onze Lieve Vrouwe Gasthuis Oost (Amsterdam), Meander Medical Center (Amersfoort), Amstelland Hospital (Amsterdam), Medical Center Alkmaar (Alkmaar), Diakonessenhuis (Utrecht), Spaarne Gasthuis (locations Haarlem and Hoofddorp) and Flevo Hospital (Almere).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available though details on statistical analyses are available from the corresponding author on request.