Cost-effectiveness Analysis of the Elder-Friendly Approaches to the Surgical Environment (EASE) Intervention for Emergency Abdominal Surgical Care of Adults Aged 65 Years and Older

Importance: The Elder-Friendly Approaches to the Surgical Environment (EASE) initiative is a novel approach to acute surgical care for elderly patients. Objective: To determine the cost-effectiveness of EASE. Design, Setting, and Participants: An economic evaluation from the perspective of the health care system was conducted as part of the controlled before-and-after EASE study at 2 tertiary care centers, the University of Alberta Hospital and Foothills Medical Centre. Participants included elderly adults (aged ≥65 years) admitted for emergency abdominal surgery between 2014 and 2017. Data were analyzed from April 2018 to February 2019. Main Outcomes and Measures: Data were captured at both control and intervention sites before and after implementation of the EASE intervention. Resource use was captured over 6 months of follow-up and was converted to costs. Utility was measured with the EuroQol Five-Dimensions Three-Levels instrument at 6 weeks and 6 months of follow-up. The differences-in-differences method was used to estimate the association of the intervention with cost and quality-adjusted life-years. For a subset of participants, self-reported out-of-pocket health care costs were collected using the Resource Use Inventory at 6 months. Results: A total of 675 participants were included (mean SD age, 75. 3 7. 9 years; 333 women 49. 3%), 289 in the intervention group and 386 in the control group. The mean (SD) cost per control participant was 36 995 (44 169) before EASE and 35 032 (43 611) after EASE (all costs are shown in 2018 Canadian dollars). The mean (SD) cost per intervention participant was 56 143 (74 039) before EASE and 39 001 (59 854) after EASE. Controlling for age, sex, and Clinical Frailty Score, the EASE intervention was associated with a mean (SE) cost reduction of 23. 5% (12. 5%) (P =. 02). The change in quality-adjusted life-years observed associated with the intervention was not statistically significant (mean SE, 0. 00001 0. 0001 quality-adjusted life-year; P =. 72). The Resource Use Inventory was collected for 331 participants. The mean (SE) odds ratio for having 0 out-of-pocket expenses because of the intervention, compared with having expenses greater than 0, was 15. 77 (3. 37) (P =. 02). Among participants with Resource Use Inventory costs greater than 0, EASE was not associated with a change in spending (mean SE reduction associated with EASE, 19. 1% 45. 2%; P =. 57). Conclusions and Relevance: This study suggests that the EASE intervention was associated with a reduction in costs and no change in quality-adjusted life-years. In locations that lack capacity to implement this intervention, costs to increase capacity should be weighed against the estimated costs avoided.