An Economic Evaluation of the National Surgical Quality Improvement Program (NSQIP) in Alberta, Canada

Abstract

The aim of this study was to analyze the health care costs and savings associated with quality improvement (QI) interventions initiated and implemented utilizing NSQIP. Five acute care facilities of Alberta Health Services (AHS) adopted NSQIP in 2015 for a pilot project. The cost-savings of NSQIP were estimated from the start of NSQIP to the end of 2017 under an AHS perspective using this formula: Gross cost-savings = N * (p1 – p2) * unit cost, where N was the number of surgical patients after the intervention, p1 was the probability of event occurrence (within 30 days of surgery) before the intervention, p2 was the probability of event occurrence after the intervention, and unit cost is health care cost per event. To calculate the net cost-savings, we deducted the costs of NSQIP and its interventions from the gross cost-savings. The QI initiatives initiated by NSQIP to reduce surgical events had significant impacts clinically and economically. The gross cost-savings of NSQIP were estimated at $11.4 million. Subtracting the costs of NSQIP and its interventions ($2.6 million) from the gross cost-savings, the net cost-savings were $8.8 million. The return on investment ratio was 4.3, meaning that every $1.00 invested in NSQIP would bring $4.30 in returns. The sensitivity analysis showed the probability for NSQIP to be cost-saving was 95%. QI interventions initiated and implemented utilizing NSQIP appear to be effective and cost-saving for AHS. These cost-savings would be even larger if NSQIP was prolonged in the pilot sites and/or expanded to other sites across the province.