M. A. Eid1, N. Dragnev1, C. Lamb1, S. Wong1 1Dartmouth Hitchcock Medical Center,General Surgery,Lebanon, NEW HAMPSHIRE, USA
Introduction:
Enhanced Recovery After Surgery (ERAS) is an evidence-based, multimodal pre and post-operative care pathway which results in significant improvements in patient outcomes after major surgery. Along with the decreased complication rates and recovery times, economic benefit of implementing ERAS has been widely heralded. However, it is unclear how rigorous the associated economic analyses are. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines to assess the quality of these studies.
Methods:
Using PubMed and OVID, we performed a systematic literature search to identify economic analyses evaluating the cost effectiveness of ERAS on colorectal, hepatobiliary, and gynecologic surgery in English language journals. The MESH terms included colorectal surgery, cost analysis, and ERAS. We retrieved 45 articles, of which 17 were found to be directly relevant to the topic. Each paper was evaluated against the items in the CHEERS guidelines to abstract data which formally included 7 categories with 27 specified criteria, mainly focusing on a study’s methodology (n=16) and how results are reported (n=5).
Results:
Of the 17 publications, including 14 colorectal, 2 hepatobiliary and 1 gynecologic studies, all but one paper described ERAS as being cost-effective; one study made no definitive statement regarding the cost effectiveness. However, none of the studies fully adhered to the CHEERS guidelines. Only 47% of the studies fulfilled at least 14 (50%) checklist items. All of the papers included “an explicit statement regarding the broader context of the study” and most titles identified the studies as economic evaluations. Papers generally performed poorly with regard to checklist items for methods and results. For example, none of the papers reported on choice of discount rates used for costs and outcomes. Overall, of the 16 analytic methods items, there was only an average concordance of 40%. Other key components of economic evaluations such as measurement and valuation of outcomes and assumptions underlying the decision-analytic model were not well reported.
Conclusion:
Based on our evaluation of economic analyses of ERAS protocols, the quality of these studies is generally quite poor. Less than half of the studies adhered to 50% of the CHEERS reporting guidelines though nearly all of them posited cost savings with ERAS. Although most studies claimed to be cost effective evaluations, the vast majority lacked methodologic quality and appear to be merely cost reports. Cost effective and economic analysis plays a pivotal role in evidence-based medicine, but the current literature may be limited in terms of actually evaluating costs and outcomes of interventions.