Cost Effectiveness of Additional Preoperative Telephone Call to Increase Surgical Preparedness: Analysis of a Randomized Clinical Trial

Introduction and Hypothesis

There is a need for cost effective interventions that increase surgical preparedness in urogynecology.

Methods

We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon.

Results

A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/– 3341; usual care: $8473 +/– 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/– 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI –$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796–7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $–35,925/QALY (95%CI, –$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care.

Conclusions

A preoperative telehealth call is cost effective from the society perspective.

Clinical Trial Registration

Registered with http://ClinicalTrials.gov.

Date of registration: March 26, 2019

Date of initial participant enrollment: June 5, 2019

URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471

Clinical trial identification number: NCT03890471