Cost Effectiveness Of Additional Preoperative Telephone Visit: Analysis Of A Randomized Trial On Surgical Preparedness

Surgical preparedness improves patient satisfaction and perioperative outcomes. We performed a RCT of a provider-initiated telephone visit in addition to usual preoperative counseling (TELE) versus usual preoperative counseling alone (usual care) and found that a supplemental preoperative telephone visit improved patient surgical preparedness. In this ancillary analysis our objective was to assess the cost-effectiveness of a preoperative telephone visit versus usual preoperative counseling alone. We performed a planned prospective economic evaluation concurrent with a RCT of 132 women randomized to either TELE (n = 63) or usual care (n = 69) followed for 8 weeks after surgery for stress urinary incontinence and/or pelvic organ prolapse. A within-trial analysis from the health care sector (HCS) - formal medical costs borne by third-party payers and patients - and societal perspectives (SP) - all costs regardless of who incurs - was performed as recommended by the Second Panel on Cost-Effectiveness in Health and Medicine. Costs are in 2019 U.S. dollars and include medical care, complications, patient and caregiver time, transportation, and lost productivity. A macro-costing approach was used; medical resource use was multiplied by price weights based on national Medicare reimbursement rates or published prices. Effectiveness measures include (1) quality-adjusted life-years (QALYs), calculated from the EuroQol 5D (EQ-5D), and (2) surgical preparedness, measured by the Preoperative Patient Questionnaire; with a response of “strongly agree” to “Overall, I feel prepared for my upcoming surgery.” Our primary outcome was the incremental cost effectiveness ratio (ICER) of TELE vs. usual care, defined as the difference between groups in mean cost divided by the difference in mean QALYs (i.e., QALY ICER). A secondary ICER was also calculated using surgical preparedness as the measure of effectiveness (i.e., preparedness ICER). Costs and QALYs were not discounted because of the 8-week analysis time horizon. Baseline characteristics and peri-operative course were similar between groups (Table 1). QALYs gained were similar between groups, 0.132 + 0.023 for TELE and 0.131 + 0.017 for usual care (P = 0.881). The TELE group was more prepared for surgery (83% vs 59%, P < 0.05). The cumulative mean per-person cost over 8 weeks was similar between groups from the HCS ($8,707 + 3,278 TELE vs. $8,433 + 3,099 usual care, P = 0.623) and SP ($11,119 + 5,105 TELE vs. $11,052 + 4,850 usual care, P = 0.938). The preoperative telephone intervention was cost-effective from the SP (ICER = $67,000/QALY) but not from the HCS perspective (ICER = $274,000/QALY) using the generally accepted maximum willingness to pay threshold of $150,000/QALY. The incremental cost per percentage patient surgical preparedness gained was $2.79 from the SP and $11.42 from the HCS. A provider-initiated preoperative telephone visit significantly improves patient surgical preparedness and is cost-effective from the SP.