Could Offering Physiotherapy Services in Emergency Departments Improve Patients’ Quality of Life While Reducing Healthcare Costs?
Author(s)
Rose Gagnon, MPT, MSc, PhD(c)1, Jason R. Guertin, PhD1, Kadija Perreault, PT, PhD1, Simon LaRue, MSc2, Simon Berthelot, MD, MSc1, Komi Edem Gatovo, MSc2, Simon Lafrance, PT, PhD1, Luc J. Hébert, Fellow PT, PhD, CD1;
1Université Laval, Quebec, QC, Canada, 2Population Health and Optimal Health Practices Program, CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada
1Université Laval, Quebec, QC, Canada, 2Population Health and Optimal Health Practices Program, CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada
Presentation Documents
OBJECTIVES: Numerous studies support the effectiveness of emergency department (ED) physiotherapy (PT) management for persons presenting with a musculoskeletal disorder (MSKD). However, its impact on health-related quality of life (HRQoL) and healthcare costs, for both the Public Payer and Society, has never been evaluated in Canada. We thus evaluated the incremental cost-effectiveness ratio (ICER) of two ED care models: 1) management by an emergency physician (EP), and 2) management by a PT and an EP.
METHODS: Cost-utility analysis over a three-month period based on data collected during a randomized controlled trial (n=78, 18-80, #NCT04009369). HRQoL was measured at baseline, 1 and 3 months using the EQ-5D-5L. Responses were first transformed into utility scores using the Canadian algorithm, and then into quality-adjusted life years (QALY). Participants were also asked at follow-ups to complete a standardized healthcare resource utilization questionnaire. Included cost data came from our team’s work, and the scientific and grey literature. We used multiple imputation alongside our complete case analyses to assess our conclusions’ robustness (sensitivity analyses).
RESULTS: At three months, participants managed by the PT + EP had a QALY gain of 0.196 and those by the EP alone of 0.181. The average cost per patient in the EP group for the Public Payer was $814.18 and $1,276.99 for Society, compared with $496.94 and $838.18 respectively in the PT + EP group [2019 CAD]. Management by a PT + EP was found to be dominant, with an ICER of $-20,926.94/QALY for the Public Payer and $-28,947.10/QALY for Society. Sensitivity analyses supported these results, with ICERs of $-10,457.74/QALY for the Public Payer and $-25,077.92 for Society.
CONCLUSIONS: The introduction of new ED professional roles and responsibilities may have the potential to reduce expenses for the Public Payer and Society, while improving the medium-term HRQoL of persons presenting to the ED with a MSKD.
METHODS: Cost-utility analysis over a three-month period based on data collected during a randomized controlled trial (n=78, 18-80, #NCT04009369). HRQoL was measured at baseline, 1 and 3 months using the EQ-5D-5L. Responses were first transformed into utility scores using the Canadian algorithm, and then into quality-adjusted life years (QALY). Participants were also asked at follow-ups to complete a standardized healthcare resource utilization questionnaire. Included cost data came from our team’s work, and the scientific and grey literature. We used multiple imputation alongside our complete case analyses to assess our conclusions’ robustness (sensitivity analyses).
RESULTS: At three months, participants managed by the PT + EP had a QALY gain of 0.196 and those by the EP alone of 0.181. The average cost per patient in the EP group for the Public Payer was $814.18 and $1,276.99 for Society, compared with $496.94 and $838.18 respectively in the PT + EP group [2019 CAD]. Management by a PT + EP was found to be dominant, with an ICER of $-20,926.94/QALY for the Public Payer and $-28,947.10/QALY for Society. Sensitivity analyses supported these results, with ICERs of $-10,457.74/QALY for the Public Payer and $-25,077.92 for Society.
CONCLUSIONS: The introduction of new ED professional roles and responsibilities may have the potential to reduce expenses for the Public Payer and Society, while improving the medium-term HRQoL of persons presenting to the ED with a MSKD.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE87
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)