Cost analysis of the stroke volume variation guided perioperative hemodynamic optimization – an economic evaluation of the SVVOPT trial results

Abstract

BackgroundPerioperative goal directed therapy (GDT) can substantially improve the outcomes of high risk surgical patients as shown by many clinical studies. However, the approach needs initial investment and can increase the already very high staff workload. These economic imperatives may be at least partly responsible for weak adherence to the GDT concept. A few models are available for the evaluation of GDT cost-effectiveness, but studies of real economic data based on a recent clinical trial are lacking. In order to address this we have performed a retrospective analysis of the data from the “Intraoperative fluid optimization using stroke volume variation in high risk surgical patients” trial (ISRCTN95085011).MethodsThe health-care payers perspective was used in order to evaluate the perioperative hemodynamic optimization costs. Hospital invoices from all patients included in the trial were extracted. A direct comparison between the study (GDT, N = 60) and control (N = 60) groups was performed. A cost tree was constructed and major cost drivers evaluated.ResultsThe trial showed a significant improvement in clinical outcomes for GDT treated patients. The mean cost per patient were lower in the GDT group 2877 ± 2336€ vs. 3371 ± 3238€ in controls, but without reaching a statistical significance (p = 0.596). The mean cost of all items except for intraoperative monitoring and infusions were lower for GDT than control but due to the high variability they all failed to reach statistical significance. Those costs associated with clinical care (68 ± 177€ vs. 212 ± 593€; p = 0.023) and ward stay costs (213 ± 108€ vs. 349 ± 467€; p = 0.082) were the most important differences in favour of the GDT group.ConclusionsIntraoperative fluid optimization with the use of stroke volume variation and Vigileo/FloTrac system showed not only a substantial improvement of morbidity, but was associated with an economic benefit. The cost-savings observed in the overall costs of postoperative care trend to offset the investment needed to run the GDT strategy and intraoperative monitoring.Trial registrationISRCTN95085011

Hemodynamic monitoring devices: Putting it all together

“…In an attempt to address the cost of implementing SVV-guided perioperative hemodynamic optimization, Benes et al reviewed economic data from the Intraoperative Fluid Optimization using Stroke Volume Variation in High Risk Surgical Patients trial [69]. They demonstrated that goal-directed therapy did not reduce mean cost per patient compared to conventional therapy in a statistically significant manner, although it did trend towards lower cost (Goal-directed: V2877 ± 2336 vs.…”

Impact of perioperative hemodynamic optimization therapies in surgical patients: economic study and meta-analysis

“…Studies and meta-analyses have shown that perioperative hemodynamic optimization therapy has a significant impact on the outcomes of high-risk patients undergoing major surgery, potentially decreasing morbidity and mortality, the length of ICU stay, and the length of hospital stay [9][10][11]. However, the risk-benefit ratio of this type of monitoring has been questioned because it is invasive and carries risks [12]. Monitoring techniques include pulmonary artery catheterization, transpulmonary thermodilution, echocardiography, transesophageal Doppler echocardiography, pulse contour analysis, partial carbon dioxide rebreathing and bioimpedance.…”

Impact of perioperative hemodynamic optimization therapies in surgical patients: Economic study and Meta-analysis

“…Studies and meta-analyses have shown that perioperative hemodynamic optimization therapy has a significant impact on the outcomes of high-risk patients undergoing major surgery, potentially decreasing morbidity and mortality, length of ICU stay, and length of hospital stay [9][10][11]. However, the risk-benefit ratio of this type of monitoring has been questioned because it is invasive and carries risks [12]. Monitoring techniques include pulmonary artery catheterization, transpulmonary thermodilution, echocardiography, transesophageal Doppler echocardiography, pulse contour analysis, partial carbon dioxide rebreathing and bioimpedance.…”