Cost-effectiveness of the national surgical quality improvement program

OBJECTIVE: The purpose of this study was to compare the cost-effectiveness of the National Surgical Quality Improvement Program (NSQIP) at an academic medical center between the first 6 months and through the first and second years of implementation. BACKGROUND: The NSQIP has been extended to private-sector hospitals since 1999, but little is known about its cost-effectiveness. METHODS: Data included 2229 general or vascular surgeries, 699 of which were conducted after NSQIP was in place for 6 months. We estimated an incremental cost-effectiveness ratio (ICER) comparing costs and benefits before and after the adoption of NSQIP. Costs were estimated from the perspective of the hospital and included hospital costs for each admission plus the total annual cost of program adoption and maintenance, including administrator salary, training, and information technology costs. Effectiveness was defined as events avoided. Confidence intervals and a cost-effectiveness acceptability curve were computed by using a set of 10,000 bootstrap replicates. The time periods we compared were (1) July 2007 to December 2007 to July 2008 to December 2008 and (2) July 2007 to June 2008 to July 2008 to June 2009. RESULTS: The incremental costs of the NSQIP program were $832 and $266 for time periods 1 and 2, respectively, yielding ICERs of $25,471 and $7319 per event avoided. The cost-effectiveness acceptability curves suggested a high probability that NSQIP was cost-effective at reasonable levels of willingness to pay. CONCLUSIONS: In these data, not only did NSQIP appear cost-effective, but also its cost-effectiveness improved with greater duration of participation in the program, resulting in a decline to 28.7% of the initial cost.