• Lawrence Lee, Juan Mata, Gabriela A Ghitulescu, Marylise Boutros, Patrick Charlebois, Barry Stein, A Sender Liberman, Gerald M Fried, Nancy Morin, Franco Carli, Eric Latimer, and Liane S Feldman.
• *Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada †Division of Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada ‡Department of Anaesthesia, McGill University Health Centre, Montreal, Quebec, Canada §Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
• Ann. Surg. 2015 Dec 1;262(6):1026-33.

ObjectiveTo determine the cost-effectiveness of enhanced recovery pathways (ERPs) versus conventional care for patients undergoing elective colorectal surgery.BackgroundERPs for colorectal surgery are clinically effective, but their cost-effectiveness is unknown.MethodsA multi-institutional prospective cohort cost-effectiveness analysis was performed. Adult patients undergoing elective colorectal resection at 2 university-affiliated institutions from October 2012 to October 2013 were enrolled. One center used an ERP, whereas the other did not. Postoperative outcomes were recorded up to 60 days. Total costs were reported in 2013 Canadian dollars. Effectiveness was measured using the SF-6D, a health utility measure validated for postoperative recovery. Uncertainty was expressed using bootstrapped estimates (10,000 repetitions).ResultsA total of 180 patients were included (conventional care: n = 95; ERP: n = 95). There were no differences in patient characteristics except for a higher proportion of laparoscopy in the ERP group. Mean length of stay was shorter in the ERP group (6.5 vs 9.8 days; P = 0.017), but there were no differences in complications or readmissions. Patients in the ERP group returned to work quicker and had less caregiver burden. There was no difference in quality of life between the 2 groups. The cost of the ERP program was $153 per patient. Overall societal costs were lower in the ERP group (mean difference = -2985; 95% confidence interval, -5753 to -373). The ERP had a greater than 99% probability of cost-effectiveness. The results were insensitive to a range of assumptions and subgroups.ConclusionsEnhanced recovery is cost-effective compared with conventional perioperative management for elective colorectal resection.

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