# Impact of the Eras Protocols on Costs and Benefits in Two Italian Second-Level Healthcare Centers According to the National Waiting List Management Plan (PNGLA)

## TL;DR

This study evaluates the cost-effectiveness of the ERAS program in two Italian hospitals for colon cancer surgery and hip replacement, finding it beneficial even with partial implementation.

## Contribution

The study demonstrates the feasibility and cost-benefit of ERAS protocols in second-level healthcare centers, supporting sustainable health policy.

## Key findings

- In the best scenario, a 100% ERAS application yields a revenue–cost ratio of 2.92.
- Even with 50% ERAS compliance, the revenue–cost ratio remains above 1 at 1.11.
- ERAS reduces hospital stays and improves patient throughput and waiting list management.

## Abstract

Background/Objectives: To analyze the financial impact of the ERAS program in two major surgical procedures (colon resection for cancer and hip replacement) in two second-level healthcare centers. Methods: A cost–benefit analysis was carried out on four hypothetical scenarios, based on the rate of compliance with the ERAS program, focusing on the additional costs and the additional benefits deriving from the decrease in hospital stay caused by the application of the ERAS protocol, with particular regard to the interventions envisaged by the National Waiting List Management Plan (PNGLA). Results: In the most optimistic scenario, with a coefficient of application of ERAS of 100% and a number of 800 days of hospitalization gained per year, the revenue–cost ratio was equal to 2.92. In the least favorable scenario, with a coefficient of application of ERAS of 50% and a number of 400 days of hospitalization gained per year, the revenue–cost ratio was equal to 1.11. Conclusions: In all the scenarios, the revenue–cost ratio was higher than 1. Implementation of the ERAS program is feasible also in second-level centers with the costs for additional healthcare professionals. Application of the ERAS program leads to a more sustainable health policy with an improvement in the number of treated patients per year and an advantage in the waiting list.