Cost Effectiveness of Additional Preoperative Telephone Call to Increase Surgical Preparedness: Analysis of a Randomized Clinical Trial.

INTRODUCTION AND HYPOTHESIS: There is a need for cost effective interventions that increase surgical preparedness in urogynecology. METHODS: We performed an ancillary prospective economic evaluation of the Telehealth Intervention to Increase Patient Preparedness for Surgery (TIPPS) Trial, a randomized multicenter trial that evaluated the impact of a preoperative telehealth call on surgical preparedness in women undergoing urogynecologic surgery. A within-trial analysis from the health care sector and societal perspective was performed. Cost-effectiveness was computed from health care sector and societal perspectives, with an 8-week time horizon. RESULTS: A total of 126 women were included in our analysis. QALYs gained were similar between groups (telehealth 0.1414 + 0.0249; usual care 0.1409 + 0.0179). The cumulative mean per-person costs at 8 weeks from the healthcare sector perspective were telehealth call: $8696 +/- 3341; usual care: $8473 +/- 3118 (p = 0.693) and from the societal perspective were telehealth call: $11,195 + 5191; usual care: $11,213 +/- 4869 (p = 0.944). The preoperative telehealth call intervention was not cost effective from the health care sector perspective with an ICER of $460,091/QALY (95%CI -$7,382,608/QALY, $7,673,961) using the generally accepted maximum willingness to pay threshold of $150,000/QALY (Neumann et al. N Engl J Med. 371(9):796-7, 2014). From the societal perspective, because incremental costs per QALY gained were negative $-35,925/QALY (95%CI, -$382,978/QALY, $317,226), results suggest that preoperative telehealth call dominated usual care. CONCLUSIONS: A preoperative telehealth call is cost effective from the society perspective. CLINICAL TRIAL REGISTRATION: Registered with http://ClinicalTrials.gov . Date of registration: March 26, 2019 Date of initial participant enrollment: June 5, 2019 URL: https://clinicaltrials.gov/ct2/show/record/NCT03890471 Clinical trial identification number: NCT03890471.

The efficacy of viewing an educational video as a method for the acquisition of basic laparoscopic suturing skills.

STUDY OBJECTIVE: To estimate the efficacy of viewing an educational video in the acquisition of laparoscopic suturing skills. DESIGN: A prospective observational study (Canadian Task Force classification II-2). SETTING: Tertiary care academic medical institution. SUBJECTS: Twelve candidates interviewing for the female pelvic medicine and reconstructive surgery fellowship position at our institution. INTERVENTIONS: Candidates were evaluated in the laparoscopy laboratory before and after watching a 6-minute educational video on the basic principles of laparoscopic suturing. Each candidate evaluation included the following tasks: (1) introduction of a needle through a trocar (timed in seconds); (2) load and position a needle for suturing with a laparoscopic needle holder (evaluated by number of movements); (3) running continuous suture with 2 passes (timed in seconds); (4) intracorporeal knot tying with 2 throws (timed in seconds); and (5) extracorporeal knot tying with 2 knots (timed in seconds). MEASUREMENTS AND MAIN RESULTS: Wilcoxon signed rank test was used for the statistical comparison of the candidates' performance before and after viewing the video. After viewing the teaching video, the total median time to perform all timed tasks improved by 20% (115.5 seconds, p = .009). Significant improvement occurred in the median time of introducing the needle through a trocar, continuous suturing, and extracorporeal knot tying (p = .02, p = .01, and p = .003, respectively). CONCLUSION: The use of an educational video appears to be an effective method for the acquisition of basic laparoscopic suturing skills.