Cost Analysis of the Enhanced Recovery After Surgery Protocol in Patients Undergoing Radical Cystectomy for Bladder Cancer

Background: Enhanced recovery after surgery (ERAS) protocols for radical cystectomy (RC) aim to improve patient care, reduce complications, and shorten hospital stay while potentially reducing health care expenditure. Objective: Evaluate the ERAS protocol for 30-d global costs relative to standard management in the era immediately preceding the initiation of ERAS for RC. Design, setting, and participants: Overall, 201 consecutive patients (99 with standard management, 102 with an ERAS protocol) who met inclusion criteria and who underwent open RC at a single institution were evaluated. Resource-based costs were collected for the initial surgical admission and for any readmissions or unscheduled clinic visits within 30 d. Intervention: Implementation of the ERAS protocol. Outcome measurements and statistical analysis: Line-item billing data were transformed using resource-based cost estimates. Tukey-Kramer least squares mean analysis was performed to adjust for cost differences attributable to patient characteristics on multivariate analysis (age <70 yr, male sex, and Charlson comorbidity score 0-1). Adjusted overall costs for the standard and ERAS cohorts were calculated with each line item assigned to 1 of 10 cost centers to identify specific areas of savings or increased expenditures with implementation of ERAS. Results and limitations: Average 30-d costs were $31 139 with standard management and $26 650 after implementation of ERAS, for savings of $4488 per procedure (p < 0.0001). Areas of significant ERAS savings included intensive care unit care ($2056), surgical ward costs ($2029), ancillary treatment ($1279), and supplies ($1238), whereas increased ERAS expenditures included costs for drugs ($2088), home health ($590), and unscheduled outpatient visits ($162). Surgical/anesthesia costs were similar between the standard and ERAS groups at $6405 and $6286 respectively. This was a single-institution study. Conclusions: In addition to clinical benefits, ERAS for RC at our institution also afforded an average cost savings of $4488 per procedure. Patient summary: In this report, we evaluated the cost center-specific expenditures of the ERAS protocol for RC, demonstrating $4488 savings in 30-d costs relative to standard management. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.