Cost evaluation of a multimodal prehabilitation program for high-risk lung cancer surgery.

Abstract

Although multimodal prehabilitation has demonstrated clinical benefits, limited data exist on its economic impact. This study evaluated the cost impact of multimodal prehabilitation for high-risk patients scheduled for lung cancer surgery. This cost analysis used data from a published propensity score-matched cohort study of 284 adults (142 per group) who underwent lung surgery between 2018 and 2024. All patients received usual care and enhanced recovery after surgery protocols; the intervention group also completed a multimodal prehabilitation program. A bottom-up microcosting approach-an itemized assessment of resource consumption and cost per unit consumed-and a per diem cost analysis were used to estimate 60-day postoperative hospital costs, program implementation expenses (staff salaries only), and cost savings in 2024 Canadian dollars (CAD) (1 CAD = 0.73 US dollar). The program implementation cost in CAD was CAD$54,979, CAD$387 per patient. Total 60-day postoperative hospital costs were CAD$2.08 million in the prehabilitation group compared to CAD$3.07 million in the control group, with mean cost reduction -CAD$1538 (95% CI, -CAD$2916 to -CAD$161) for surgical ward and -CAD$21,094 (95% CI, -CAD$37,028 to -CAD$5160) for intensive care unit care. Prehabilitation was associated with net cost savings of CAD$721,901 (CAD$5084 per patient). The main drivers of these savings were reductions in overall complications (45.1% vs 64.7%; P = .001), intensive care unit admissions (2.1% vs 8.4%; P = .031), hospital days (median, 3 vs 4 days; P = .049), and readmission rate (6.3% vs 13.3%; P = .044). Multimodal prehabilitation is a clinically effective and economically beneficial intervention for high-risk patients undergoing lung cancer surgery, supporting its integration into standard perioperative care.