The economics of Enhanced Postoperative Care: The ARRC Model
A single published paper examines the economics of EPOCs using the ARRC model, based on a single-centre cohort study comparing EPOC management to ward care.
Base case (deterministic) results
ARRC produced 4.3 additional DAH within 90 days of surgery (67.8 vs 63.5 days) at a mean reduction in hospital cost of A$1,081 per patient (A$23,734 vs A$24,815), yielding a dominant ICER of −251.
Probabilistic sensitivity analysis (10,000 simulations)
The mean incremental cost was −A$1,135 (95% CI −A$1,164 to −A$1,105) and mean incremental DAH was 4.3 (95% CI 4.3–4.4). ARRC improved DAH90 in 99.3% of simulations and reduced costs in 77.4%, with 77.4% of simulations falling in the dominant quadrant. At a willingness-to-pay threshold of A$1,000 per additional DAH, 99.3% of simulations were cost-effective.
Patient flow findings
Compared to usual care, ARRC patients returned home sooner, spent less time in supported care, had fewer post-discharge emergency department presentations, were readmitted less frequently, and had approximately half the cumulative 90-day mortality.
Cost dynamics
The net cost benefit of ARRC was not realised until approximately 45–48 days after surgery, reflecting the upfront cost of the ARRC intervention being offset by downstream savings from reduced complications, readmissions, and supported care. The cost-effectiveness was most sensitive to the unit cost of ARRC itself and to ward-supported care and readmission costs.
Conclusion
ARRC is a dominant intervention for medium-risk noncardiac surgical patients, delivering both improved patient outcomes and reduced hospital costs compared to standard ward care. The authors note that DAH should be measured to 90 days rather than the conventional 30 days to capture the full benefit, and that the Markov model is adaptable for use in other jurisdictions.