Protocol Implementation for Normothermia in Surgery Settings in Italy: Budget-Impact Analysis

Abstract

Introduction

Hypothermia is a well-known risk of the perioperative period and considered a preventable effect of anesthesia care. Nevertheless, it is not fully controlled, causing a number of adverse outcomes following surgical operations and thus increasing length of stay in hospital and treatment costs. The aim of this study was to assess the budget impact (BI) of the implementation of proactive strategies to prevent inadvertent perioperative hypothermia (IPH) in surgical patients in Italy, as recommended by international guidelines and by a good clinical practice (GCP) guideline of the Italian Society of Anesthesia, Analgesia, Reanimation, and Intensive Care.

Methods

BI was calculated over a 3-year period from the perspective of the Italian National Health Service (NHS). Model inputs were extracted from national literature when available and otherwise from international sources. The reference analytic model was based on the cost-effectiveness analysis of the National Institute for Health and Care Excellence clinical guidance 65. Estimates were based on assessments made about current malpractice in Italy and on a hypothesis of how future practice might change by implementing the GCP. Model output included overall BI results, variations in the number of warmed patients, medical-device average costs and use of mix.

Results

The base-case estimate quantified a decrease of 35% in extra days of hospital stay due to IPH and a net BI of –€60.92 million.

Conclusion

Increasing protocol adoption for preventing IPH would lead to both clinical advantages and significant savings for the NHS. Its large diffusion in Italian hospitals is thus desirable.

Keywords:

• budget-impact analysis
• active-warming systems
• inadvertent perioperative hypothermia
• Italy
• perioperative warming

Acknowledgments

We thank Dr Emiliano Tizi and all SIAARTI for scientific support, Dr Laura Benedan for editorial assistance, and Dr Maddalena Iannantuoni for graphical support. This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sector.

Disclosure

The authors report no conflicts of interest in this work.