Overcoming time-to-surgery challenges for acute cholecystitis through dedicated day surgery supported by remote patient monitoring: a cost-effectiveness economic modelling study (Preprint)

BACKGROUND Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored. OBJECTIVE This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis. METHODS Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years (QALYs)), and healthcare costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Healthcare costs were estimated from the Australian healthcare funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. RESULTS The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model vs. 1.5 days for the acute day-surgery model) and lowering net healthcare costs by a mean of $1,416 per case over the 1-year time horizon. There was no meaningful difference in QALYs between care models. These results remained robust in both deterministic and probabilistic sensitivity analyses. CONCLUSIONS An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the healthcare system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.