Institutional budget impact and financial viability of a trimodal prehabilitation program in oncologic surgery: a five-year analysis in a public hospital

Abstract Background Although trimodal prehabilitation programs have demonstrated clinical benefits in oncologic surgery, evidence regarding their financial sustainability in public health systems of middle-income countries remains limited. Objective To assess the institutional budget impact and financial viability of implementing a trimodal prehabilitation program for oncologic surgical patients in a public regional hospital. Methods A five-year Budget Impact Analysis was conducted from the hospital perspective. The model incorporated an initial capital investment of CLP 24,773,549 and an annual operating cost of CLP 92,400,000, with a projected annual enrollment of 380 patients. Cost offsets were primarily driven by expected reductions in postoperative hospital length of stay, while reductions in major postoperative complications were incorporated as complementary clinical-economic indicators. A 10% annual discount rate was applied. Net present value (NPV) and internal rate of return (IRR) were calculated to assess financial performance. Results The estimated cost per treated patient was CLP 243,158, while projected annual cost offsets averaged CLP 287,000 per patient. The program generated an annual net benefit of approximately CLP 16,660,000. Over a five-year horizon, the discounted NPV was CLP 38,382,700, with an IRR of 43%. Sensitivity analyses demonstrated that financial viability was primarily dependent on the magnitude of hospital length-of-stay reduction. Conclusion Under base-case assumptions, implementation of a trimodal prehabilitation program in a public hospital setting appears financially sustainable, with projected returns exceeding the institutional discount threshold. These findings suggest that perioperative optimization strategies may represent an economically viable investment for resource-constrained health systems.