Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture
IntroductionBefore implementing a new health care strategy, it is important to assess effectiveness but also to perform an economic evaluation. The goal of the present study was to perform a comparative economic evaluation of a new strategy aimed at using proposed implementation of the Plateletworks...
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Frontiers Media S.A.
2025-01-01
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| author | Claudia Erika Delgado-Espinoza Rosa Maria Antonijoan Ignasi Gich Ignasi Gich Rafael Anaya Mireia Rodriguez Angélica Millan Jordi Llorca Gemma Usua Ana Ruiz Angela Merchán-Galvis Angela Merchán-Galvis Maria Jose Martinez-Zapata Maria Jose Martinez-Zapata |
| author_facet | Claudia Erika Delgado-Espinoza Rosa Maria Antonijoan Ignasi Gich Ignasi Gich Rafael Anaya Mireia Rodriguez Angélica Millan Jordi Llorca Gemma Usua Ana Ruiz Angela Merchán-Galvis Angela Merchán-Galvis Maria Jose Martinez-Zapata Maria Jose Martinez-Zapata |
| author_sort | Claudia Erika Delgado-Espinoza |
| collection | DOAJ |
| description | IntroductionBefore implementing a new health care strategy, it is important to assess effectiveness but also to perform an economic evaluation. The goal of the present study was to perform a comparative economic evaluation of a new strategy aimed at using proposed implementation of the Plateletworks guidance (measurement of platelet function) with usual practice (delayed time to surgery) in patients on chronic antiplatelet treatment and scheduled for surgery with neuraxial anaesthesia due to proximal femur fracture.MethodsThis is an economic evaluation carried out alongside a randomised controlled clinical trial at four centres in Spain. Patients were randomised to undergo either early platelet function-guided surgery (experimental group) or delayed surgery (control group). As AFFEcT trial results demonstrated significative difference between groups in the primary efficacy endpoint, the median time to surgery, a cost-effectiveness analysis was performed. Direct costs associated with hospitalisation until one-month post-discharge were considered and measured from a hospital perspective. All costs were reported in euros. Analyses were performed on a per protocol basis. Effectiveness outcome measures were the incremental cost and incremental cost per reduction in days to surgery. A deterministic sensitivity analysis was implemented to quantify uncertainty.ResultsA total of 156 patients were randomized to the two groups (n = 78 per group). A total of 143 patients were included in the per protocol population (75 and 68 patients in the experimental and control groups, respectively). The median time to surgery was 2.30 days (IQR: 1.53–3.73) in the experimental group and 4.87 days (4.36–5.60) in the control group (a reduction of 2.40 days). Total costs during the 1-month study perioperative period were higher in the delayed surgery group (€18,495.19) than for the early surgery group (€16,497.59). The incremental cost was negative (€1,997.60), a statistically significant difference (P < 0.05). As measured by the reduction in time (days) to surgery, the incremental cost-effectiveness ratio (ICER) for early surgery was negative (777.28€/day). Sensitivity analysis demonstrated consistent cost saving.ConclusionFor patients on chronic antiplatelet treatment scheduled to undergo surgery for proximal femur fracture, an individualised strategy guided by a platelet function testing is a cost-saving and cost-effective strategy. |
| format | Article |
| id | doaj-art-7480316734f24dfaa727e80f3b459ab9 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-7480316734f24dfaa727e80f3b459ab92025-01-20T07:19:54ZengFrontiers Media S.A.Frontiers in Health Services2813-01462025-01-01410.3389/frhs.2024.14239751423975Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fractureClaudia Erika Delgado-Espinoza0Rosa Maria Antonijoan1Ignasi Gich2Ignasi Gich3Rafael Anaya4Mireia Rodriguez5Angélica Millan6Jordi Llorca7Gemma Usua8Ana Ruiz9Angela Merchán-Galvis10Angela Merchán-Galvis11Maria Jose Martinez-Zapata12Maria Jose Martinez-Zapata13Clinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainClinical Pharmacology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainClinical Epidemiology and Public Health Service, Fundació Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, SpainCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health), Madrid, SpainAnaesthesiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainAnaesthesiology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainOrthopedic and Traumatology Surgery Service, Hospital de la Santa Creu i Sant Pau, Barcelona, SpainAnaesthesiology Service, Xarxa Assistencial Universitària de Manresa, Barcelona, SpainAnaesthesiology Service, Hospital de la Vall d’Hebron, Barcelona, SpainAnaesthesiology Service, Hospital Clinic de Barcelona, Barcelona, SpainDepartamento de Medicina Social y Salud Familiar, Universidad del Cauca, Popayan, Colombia0Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, Institut de Recerca Sant Pau, Barcelona, SpainCentro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health), Madrid, Spain0Public Health and Clinical Epidemiology Service-Iberoamerican Cochrane Centre, Institut de Recerca Sant Pau, Barcelona, SpainIntroductionBefore implementing a new health care strategy, it is important to assess effectiveness but also to perform an economic evaluation. The goal of the present study was to perform a comparative economic evaluation of a new strategy aimed at using proposed implementation of the Plateletworks guidance (measurement of platelet function) with usual practice (delayed time to surgery) in patients on chronic antiplatelet treatment and scheduled for surgery with neuraxial anaesthesia due to proximal femur fracture.MethodsThis is an economic evaluation carried out alongside a randomised controlled clinical trial at four centres in Spain. Patients were randomised to undergo either early platelet function-guided surgery (experimental group) or delayed surgery (control group). As AFFEcT trial results demonstrated significative difference between groups in the primary efficacy endpoint, the median time to surgery, a cost-effectiveness analysis was performed. Direct costs associated with hospitalisation until one-month post-discharge were considered and measured from a hospital perspective. All costs were reported in euros. Analyses were performed on a per protocol basis. Effectiveness outcome measures were the incremental cost and incremental cost per reduction in days to surgery. A deterministic sensitivity analysis was implemented to quantify uncertainty.ResultsA total of 156 patients were randomized to the two groups (n = 78 per group). A total of 143 patients were included in the per protocol population (75 and 68 patients in the experimental and control groups, respectively). The median time to surgery was 2.30 days (IQR: 1.53–3.73) in the experimental group and 4.87 days (4.36–5.60) in the control group (a reduction of 2.40 days). Total costs during the 1-month study perioperative period were higher in the delayed surgery group (€18,495.19) than for the early surgery group (€16,497.59). The incremental cost was negative (€1,997.60), a statistically significant difference (P < 0.05). As measured by the reduction in time (days) to surgery, the incremental cost-effectiveness ratio (ICER) for early surgery was negative (777.28€/day). Sensitivity analysis demonstrated consistent cost saving.ConclusionFor patients on chronic antiplatelet treatment scheduled to undergo surgery for proximal femur fracture, an individualised strategy guided by a platelet function testing is a cost-saving and cost-effective strategy.https://www.frontiersin.org/articles/10.3389/frhs.2024.1423975/fullfemur fractureplatelet function testeconomic evaluationrandomised clinical trialneuraxial anaesthesia |
| spellingShingle | Claudia Erika Delgado-Espinoza Rosa Maria Antonijoan Ignasi Gich Ignasi Gich Rafael Anaya Mireia Rodriguez Angélica Millan Jordi Llorca Gemma Usua Ana Ruiz Angela Merchán-Galvis Angela Merchán-Galvis Maria Jose Martinez-Zapata Maria Jose Martinez-Zapata Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture Frontiers in Health Services femur fracture platelet function test economic evaluation randomised clinical trial neuraxial anaesthesia |
| title | Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| title_full | Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| title_fullStr | Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| title_full_unstemmed | Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| title_short | Economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| title_sort | economic evaluation of a strategy to shorten the time to surgery with neuraxial anaesthesia compared with usual clinical practice in patients on chronic antiplatelet therapy with a proximal femur fracture |
| topic | femur fracture platelet function test economic evaluation randomised clinical trial neuraxial anaesthesia |
| url | https://www.frontiersin.org/articles/10.3389/frhs.2024.1423975/full |
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