OBJECTIVES: Since Perioperative Goal Directed Therapy (PGDT) is considered the standard care for patients submitted to high-risk surgeries for reducing intrahospital complications, we aimed at estimating the incremental cost-effectiveness ratio of the PGDT performed with HemosPhere platform, in high-risk hip replacement surgeries, from the institutional perspective in Mexico.

METHODS: A cost effectiveness analysis was conducted using a Markov decision tree model comparing PGDT vs. conventional hemodynamic monitoring in hip replacement surgery in a one-year time horizon. Effectiveness was defined as number of life years gained (LYG) and avoided complications. Costs evaluated included the catheter unit cost, hip replacement surgery, stroke, cardiovascular and non-cardiovascular complications and were obtained from DRGs. Clinical outcomes and benefits were obtained from a clinical trial evaluating PGDT vs. non-PGDT implementation in hip replacement surgery. Incremental cost-effectiveness ratio (ICER) and probabilistic sensitivity analyses (PSA) were developed to compare to the base case results. Costs are presented in MXN (Mexican Peso).

RESULTS: Results in the base case indicate that implementing PGDT to hip replacement surgery is associated with 4.3 LYG and a total cost of $420,958, while conventional monitoring is associated with 2.9 LYG and $512,783. PGDT gains 1.4 LY while generating $169,465 savings indicating that is a dominant alternative (more effective and less costly) compared to conventional monitoring in high-risk hip replacement surgery. PSA demonstrated PGDT was dominant in 100% of the simulations.

CONCLUSIONS: Implementing PGDT in high-risk hip replacement surgery is a dominant alternative compared to conventional monitoring as it improves patient LYs by reducing the probability of complications while presenting savings for the Mexican Institutions. Our analysis demonstrates that complications have a great impact on healthcare costs and that implementing PGDT during a high-risk surgery significantly reduces them. We expect these results to be reproducible in other high-risk surgeries as well.