The cost-effectiveness of an outpatient anesthesia consultation clinic before surgery: a matched Hong Kong cohort study

A total of 352 patients were matched (1:1) on their elective surgical procedure to either the clinic group or to the conventional group. The primary outcome was quality of recovery score and overall perioperative treatment cost (US$). To detect a difference in the joint cost-effect relationship between groups, a cost-effectiveness acceptability curve (CEAC) was drawn. A modified Poisson regression model was used to examine the factors associated with patients willing to pay more than the median WTP value for an OPAC.The quality of recovery scores on the first day after surgery between the clinic and conventional groups were similar (mean difference, -0.1; 95% confidence interval (CI), -0.6 to 0.3; P？=？0.57). Although the preoperative costs were less in the clinic group (mean difference, -$463, 95% CI, -$648 to -$278 per patient; P <0.001), the total perioperative cost was similar between groups (mean difference, -$172; 95% CI, -$684 to $340 per patient; P？=？0.51). The CEAC showed that we could not be 95% confident that the clinic was cost-effective. Compared to the conventional group, clinic patients were three times more likely to prefer OPAC care (relative risk (RR) 2.75, 95% CI, 2.13 to 3.55; P <0.001) and pay more than the median WTP (US$13) for a clinic consultation (RR 3.27, 95% CI, 2.32 to 4.64; P <0.001).There is uncertainty about the cost-effectiveness of an OPAC in the Hong Kong setting. Most clinic patients were willing to pay a small amount for an anesthesia clinic consultation.Healthcare systems of today place much emphasis on patient-centered quality outcomes and cost effectiveness. Compared to a conventional system of admitting patients at least a day before surgery, Perioperative Systems with outpatient anesthesia consultation clinics are well established in North America [1-3], Europe [4] and Australia [5,6]. While there are significant variations in the development of these Perioperative Systems between hospitals and health systems both within indi