Correction: Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Schaller, Stefan; Kiselev, Jörn; Loidl, Verena; Quentin, Wilm; Schmidt, Karl‐Hermann; Mörgeli, Rudolf; Rombey, Tanja; Busse, Reinhard; Mansmann, Ulrich; Spies, Claudia

doi:10.1186/s13063-023-07106-5

Cited by 4 publications

(15 citation statements)

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“…Reporting of this protocol followed the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) (25,26). Parts of the description of the study population and intervention are adapted from the publication of the trial protocol (27).…”

Section: Methodsmentioning

confidence: 99%

“…The PRAEP-GO trial was registered with ClinicalTrials.gov (NCT04418271 (28)) on 5 June 2020 (27,28). The investigators plan to recruite 1 400 trial participants over 3 years (enrolment period 30 June 2020 to 30 June 2023) (27,28).…”

Section: The Praep-go Rctmentioning

confidence: 99%

“…The PRAEP-GO trial enrols frail or pre-frail patients undergoing elective surgery in Germany satisfying the following inclusion criteria (27,28): i) age ≥ 70 years, ii) planned elective surgery/interventional procedure, iii) expected duration of anaesthesia > 60 min, and iv) prefrail or frail based on Fried's frailty phenotype. Patients are de ned as pre-frail with at least one item indicated as positive and as frail with three or more positive items of Fried's frailty phenotype.…”

Section: Target Populationmentioning

confidence: 99%

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Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Eckhardt,

Quentin,

Silzle

et al. 2023

Preprint

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Background Prehabilitation aims to improve patients' functional capacity before surgery to reduce perioperative complications, promote recovery and decrease probability of disability. The planned economic evaluation is performed alongside a large German multi-centre pragmatic, two-arm parallel-group, randomized controlled trial on prehabilitation for frail elderly patients before elective surgery compared to standard care (PRAEP-GO RCT). The aim is to determine the cost-effectiveness and cost-utility of prehabilitation for frail elderly before an elective surgery. Methods The planned health economic evaluation comprises cost-effectiveness, cost-utility, and cost-minimisation analyses. Analyses are conducted in the German context from different perspectives including the payer perspective, i.e. the statutory health insurance, the societal perspective and the health care provider perspective. Data on outcomes and costs, are collected alongside the ongoing PRAEP-GO RCT. The trial population includes frail or pre-frail patients aged ≥70 years with planned elective surgery. The intervention consists of frailty screening (Fried phenotype), a shared decision-making conference determining modality (physiotherapy and unsupervised physical exercises, nutrition counselling, etc.) and setting (inpatient, day care, outpatient etc.) of a 3-week individual multimodal prehabilitation prior to surgery. The control group receives standard preoperative care. Costs include the intervention costs, the costs of the index hospital stay for surgery, and health care resources consumed during a 12-month follow-up. Clinical effectiveness outcomes included in the economic evaluation are the level of care dependency, the degree of disability as measured by the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality-adjusted life years (QALY) derived from the EQ-5D-5L and the German utility set, and complications occurring during the index hospital stay. Each adopted perspective considers different types of costs and outcomes as outlined in the protocol. All analyses will feature Intention-To-Treat analysis. To explore methodological and parametric uncertainties, we will conduct probabilistic and deterministic sensitivity analyses. Subgroup analyses will be performed as secondary analyses. Discussion The health economic evaluation will provide insights into the cost-effectiveness of prehabilitation in older frail populations, informing decision-making processes and contributing to the evidence base in this field. Potential limitation includes a highly heterogeneous trial population. Trial registration PRAEP-GO RCT: NCT04418271; economic evaluation: OSF (https://osf.io/swn79/ registration initiated on 29.06.2023).

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Section: Methodsmentioning

confidence: 99%

Section: The Praep-go Rctmentioning

confidence: 99%

Section: Target Populationmentioning

confidence: 99%

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Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Eckhardt,

Quentin,

Silzle

et al. 2023

Preprint

Self Cite

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“…We plan to update the review upon publication of our own economic evaluation (57) in 2025/26 by re-running the search strategies modi ed only by adding the MeSH/Emtree term 'Preoperative Exercise'.…”

Section: Update Of the Reviewmentioning

confidence: 99%

“…All raw data collected as part of the review are deposited in the Open Science Framework (OSF), available from: https://osf.io/w3b4y/?view_only=0d2b0da535e247b98833af96d9128c98 Competing interests TR, HE, JS, JK and WQ are involved in one of the included ongoing economic evaluations (57). TM declares to have no competing interests.…”

Section: Consent For Publicationmentioning

confidence: 99%

Cost-effectiveness of prehabilitation prior to elective surgery: A systematic review of economic evaluations

Rombey,

Eckhardt,

Kiselev

et al. 2023

Preprint

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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 regardless of design, analysis type and completion status. 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. Among the completed EEs, there were 22 trial-based EEs, and three model-based EEs, 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. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective based on direction of effects. 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, and in one EE prehabilitation was not cost-effective. Discussion 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. Funding information and systematic review registration Funding: Innovationsausschuss of the Federal Joint Committee (G-BA) (01NVF18024). Registration: PROSPERO CRD42020182813.

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How much does it cost to be fit for operation? The economics of prehabilitation

Crişan,

Slankamenac,

Bilotta

2024

Current Opinion in Anaesthesiology

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Purpose of review Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs. Recent findings The current literature regarding the economics of prehabilitation is limited. However, such programs have been mainly associated with either a reduction in total healthcare related costs or no increase. Summary Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.

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Correction: Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

Cited by 4 publications

References 1 publication

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Cost-effectiveness of prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO) versus usual care – Protocol for a health economic evaluation alongside a randomized controlled trial

Cost-effectiveness of prehabilitation prior to elective surgery: A systematic review of economic evaluations

How much does it cost to be fit for operation? The economics of prehabilitation

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