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.