PATIENT-LEVEL COST MINIMISATION ANALYSIS OF AN ACUTE MEDICAL UNIT EXPEDITING GENERAL MEDICINE INPATIENT CARE IN A TERTIARY HOSPITAL IN SINGAPORE
Author(s)
Stephanie A. Fernandez, MPH, Juvenia Neo, BSc (Hons), Megan Phua, BBM (Hons), Huiling Guo, PhD, Geralyn Ong, BOE (Hons), Yan Qing Lee, BA (Hons), Eunice Lim, BSc (Hons), Lip Hong Tan, MRCP, MBBS, Angela Chow, PhD, Nihar Pandit, MRCP, MBBS.
Tan Tock Seng Hospital, Singapore, Singapore.
Tan Tock Seng Hospital, Singapore, Singapore.
OBJECTIVES: Increasing inpatient demand driven by an ageing population prompted the introduction of an Acute Medical Unit (AMU), a clinical service model within the General Medicine Department, to deliver expedited diagnosis and early treatment to reduce inpatient length of stay (LOS). This study evaluates the impact of AMU on patient-level costs, compared with standard care, to inform decisions for programme scale-up.
METHODS: This quasi-experimental study compared the costs incurred by patients eligible (i.e. anticipated LOS of ≤5 days) and admitted to AMU and patients eligible but not admitted to AMU due to refusal or bed unavailability, for index admission episodes between October 2025 and January 2026. Costs were derived by multiplying 1) unit costs of manpower, supplies, facility, and miscellaneous items per patient-day in a subsidised medical ward by each patient’s LOS, and 2) costs of allied health (AH) services and diagnostics by number of service utilisation. Mean incremental costs, Student’s t-test, deterministic and probabilistic sensitivity analyses were computed in R.
RESULTS: 534 and 516 patients underwent AMU model of care and standard care respectively, with 10 AMU patients being inappropriately referred. Relative to standard care, AMU was observed to have 10% higher medical manpower cost and shorter mean LOS (4.68 vs 5.54 days; p=0.01). AMU utilised less AH service categories (occupational therapy, physiotherapy, speech therapy, podiatry, dietetics and nutrition; p<0.05) but no statistical differences were found for diagnostic modality (X-ray, ultrasound, computed tomography, magnetic resonance imaging). Mean incremental cost per patient was -$809.92 (p=0.02). A 17% increase in transfers from AMU to general ward for extended care would render AMU cost-incurring. The probability of AMU being cost-saving per patient was 100%.
CONCLUSIONS: AMU reduces patient-level costs relative to standard care. Yet, more in-depth evaluation on how AMU impacts hospital-level costs is needed to better support the case for programme scale-up.
METHODS: This quasi-experimental study compared the costs incurred by patients eligible (i.e. anticipated LOS of ≤5 days) and admitted to AMU and patients eligible but not admitted to AMU due to refusal or bed unavailability, for index admission episodes between October 2025 and January 2026. Costs were derived by multiplying 1) unit costs of manpower, supplies, facility, and miscellaneous items per patient-day in a subsidised medical ward by each patient’s LOS, and 2) costs of allied health (AH) services and diagnostics by number of service utilisation. Mean incremental costs, Student’s t-test, deterministic and probabilistic sensitivity analyses were computed in R.
RESULTS: 534 and 516 patients underwent AMU model of care and standard care respectively, with 10 AMU patients being inappropriately referred. Relative to standard care, AMU was observed to have 10% higher medical manpower cost and shorter mean LOS (4.68 vs 5.54 days; p=0.01). AMU utilised less AH service categories (occupational therapy, physiotherapy, speech therapy, podiatry, dietetics and nutrition; p<0.05) but no statistical differences were found for diagnostic modality (X-ray, ultrasound, computed tomography, magnetic resonance imaging). Mean incremental cost per patient was -$809.92 (p=0.02). A 17% increase in transfers from AMU to general ward for extended care would render AMU cost-incurring. The probability of AMU being cost-saving per patient was 100%.
CONCLUSIONS: AMU reduces patient-level costs relative to standard care. Yet, more in-depth evaluation on how AMU impacts hospital-level costs is needed to better support the case for programme scale-up.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE31
Topic
Economic Evaluation
Disease
STA: Generics