OBJECTIVES A large regional hospital in the Netherlands, providing secondary care to approximately 450,000 persons, has started an initiative that strives to drastically reduce length of stay by providing part of treatment at home. This is currently organized on a per diagnosis basis, while it is being investigated what level of scale is most appropriate. This study was intended to provide insight into this, by estimating budget impact of implementing discharge immediately after postoperative observation in the recovery ward in bariatric surgery patients facilitated by a wearable remote continuous monitoring device.

METHODS A budget impact model was developed to estimate the expected change in healthcare costs over five years, from the perspective of the hospital, resulting from reduced length of stay. Eligibility of patients was based on expert judgement, as the early discharge pathway is currently hypothetical. Resource consumption and costs were acquired from the hospital’s financial department. Complication rate is assumed to be unaffected in the base case scenario. The model was enriched with a capacity estimation model, as the primary expected source of cost savings is reducing nurse shifts.

RESULTS Additional cost of the intervention over five years is estimated to be €1,095,000; €509,400 of which is incurred in the first year, and €146,400 every year thereafter, not accounting for inflation. The majority of costs in the first year are due to investments in infrastructure and project management. In subsequent years costs originate mainly from functional management and support. Given that reducing day shifts by one during the entire week could result in savings of €100,000; reducing day shifts by two could approach cost neutrality. However, nurse shifts could not be reduced under the base case scenario.

CONCLUSIONS Implementing early discharge for one specific patient group is likely to result in additional costs. Larger numbers of eligible patients could result in savings.