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

Abstract

Economic evaluation; Femur fracture; Neuraxial anaesthesia

Evaluación económica; Fractura de fémur; Anestesia neuroaxial

Avaluació econòmica; Fractura de fèmur; Anestèsia neuroaxial

Introduction: Before 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. Methods: This 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. Results: A 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. Conclusion: For 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.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. CEDE is a Ph.D. candidate in Pharmacology at the Autonomous University of Barcelona (Spain). This research was funded by Instituto de Salud Carlos III and European Regional Development Fund (ERDF), “A way to make Europe”, grant number PI16/01879. The monitoring of the study has been supported by the Spanish Clinical Research Network (PT17/0017/0034 and PT20/00096) funded by the Instituto de Salud Carlos III and co-funded by European Regional Development Fund “A way to make Europe”. MJMZ is funded by a Miguel Servet II research contract (CPII20/00023) from the Instituto de Salud Carlos III.