University of Tasmania
140036 - preoperative physiotherapy is cost effective for preventing pulmonary complications.pdf (1.46 MB)

Preoperative physiotherapy is cost-effective for preventing pulmonary complications after major abdominal surgery: a health economic analysis of a multicentre randomised trial

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journal contribution
posted on 2023-05-20, 16:20 authored by Ianthe BodenIanthe Boden, Iain RobertsonIain Robertson, Amanda NeilAmanda Neil, Reeve, J, Andrew PalmerAndrew Palmer, Skinner, EH, Browning, L, Anderson, L, Hill, C, Story, D, Denehy, L
Question: Is preoperative physiotherapy cost-effective in reducing postoperative pulmonary complications (PPC) and improving quality-adjusted life years (QALYs) after major abdominal surgery?

Design: Cost-effectiveness analysis from the hospitals' perspective within a multicentre randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis.

Participants: Four hundred and forty-one adults awaiting elective upper abdominal surgery attending pre-anaesthetic clinics at three public hospitals in Australia and New Zealand.

Interventions: The experimental group received an information booklet and a 30-minute face-to-face session, involving respiratory education and breathing exercise training, with a physiotherapist. The control group received the information booklet only.

Outcome measures: The probability of cost-effectiveness and incremental net benefits was estimated using bootstrapped incremental PPC and QALY cost-effectiveness ratios plotted on cost-effectiveness planes and associated probability curves through a range of willingness-to-pay amounts. Cost-effectiveness modelling utilised 21-day postoperative hospital cost audit data and QALYs estimated from Short Form-Six Domain health utilities and mortality to 12 months.

Results: Preoperative physiotherapy had 95% probability of being cost-effective with an incremental net benefit to participating hospitals of A$4,958 (95% CI 10 to 9,197) for each PPC prevented, given that the hospitals were willing to pay $45,000 to provide the service. Cost-utility for QALY gains was less certain. Sensitivity analyses strengthened cost-effectiveness findings. Improved cost-effectiveness and QALY gains were detected when experienced physiotherapists delivered the intervention.

Conclusions: Preoperative physiotherapy aimed at preventing PPCs was highly likely to be cost-effective from the hospitals' perspective. For each PPC prevented, preoperative physiotherapy is likely to cost the hospitals less than the costs estimated to treat a PPC after surgery. Potential QALY gains require confirmation.


Publication title

Journal of Physiotherapy








School of Health Sciences


Elsevier Australia

Place of publication


Rights statement

© 2020 Australian Physiotherapy Association. Published by Elsevier B.V. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

Repository Status

  • Open

Socio-economic Objectives

Clinical health not elsewhere classified; Evaluation of health outcomes; Evaluation of health and support services not elsewhere classified