Economic Impact of Multidisciplinary Pre-operative Diabetes Care Versus Usual Care in Adults Undergoing Elective Non-cardiac Surgery in Australia: A Trial-Based Analysis.

AIMS: The detrimental impact of perioperative hyperglycaemia on surgical outcomes is well documented. However, economic evaluations on interventions to improve perioperative blood glucose management are lacking. This study aimed to assess the cost-effectiveness of a multidisciplinary pre-operative diabetes service compared with usual care in adults with diabetes undergoing elective non-cardiac surgery.

MATERIALS AND

METHODS

An economic evaluation was conducted using data from a 3-year prospective interventional study involving adults with sub-optimally managed diabetes who were scheduled for elective non-cardiac surgery. Analysis was from a healthcare institution perspective. A decision analytic model was used to compare healthcare costs and outcomes between an intervention arm receiving multidisciplinary pre-operative diabetes input and a simulated usual care arm. Model inputs were derived from the interventional study, National Surgical Quality Improvement Program (NSQIP) data and published literature. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model outcome.

RESULTS

The intervention arm had a lower modelled incidence of 30-day post-operative infection-related readmissions and lower total costs per patient compared with the usual care arm. The intervention avoided 7 readmissions per 100 patients treated and generated cost savings of A$3967 per patient (total cost intervention: A$8335 vs. total cost usual care: $12 302). Probabilistic sensitivity analysis revealed an 89.5% probability that the intervention would remain dominant, with lower costs and fewer post-operative infection-related readmissions than usual care.

CONCLUSIONS

In adults awaiting elective non-cardiac surgery, a multidisciplinary pre-operative diabetes service represents a cost-effective strategy compared with usual care from a healthcare institution perspective.