Endovascular training using a simulation-based curriculum is less expensive than training in the hybrid angiosuite

Background and aims: Traditionally, endovascular procedures are trained on real patients, without structured curricular support and dependent on a highly variable caseload. This study aimed to determine the cost-effectiveness of a PROficiency-based StePwise Endovascular Curricular Training (PROSPECT) program including e-learning and hands-on virtual-reality simulation. Methods: A prospective single-blinded Randomized Controlled Trial (RCT) evaluated endovascular performance of surgical trainees after conventional training (N=11), conventional training and e-learning (N=10) or structured training using the PROSPECT program (N=11). Subjects performed two supervised endovascular interventions (symptomatic iliac and/or superficial femoral artery stenosis). An analysis was performed of costs and savings related to implementation of the PROSPECT program. Developmental cost, implementation cost, training time cost and operational costs were determined. Time spent studying and practicing was converted into indirect saving of operating time. Costs of logistics, faculty time supervising simulation sessions and 30-day complication rates were registered. Sensitivity analysis was performed Results: Fifty-eight peripheral endovascular interventions, performed by 29 surgical trainees (3 drop-outs) were included in this RCT from October 2014 to February 2016. Yearly costs for the hospital include 6,589€ for curriculum design, 31,484€ for implementation and 1,143€ operational costs. Per trainee at our university, simulation-based training until proficiency would require 3,806€ in total, while obtaining endovascular proficiency levels during conventional training only, may have costed 5,001€ per trainee. Conclusions: Simulation-based training in endovascular procedures may be cost saving, because training occurs outside the angiosuite. Cost savings are possibly underestimated since prevented costs related to complications could not be defined.

Jaar van publicatie:2019