Economic Evaluation of a Standardized Care Pathway for Nontraumatic Acute Abdominal Pain in the Emergency Department
Author(s)
Lisa Arnold, MSc1, Anna Slagman, Prof. Dr.2, Martin Möckel, Prof. Dr.2, Britta Stier, MD2, Antje Fischer-Rosinský, Dr.2, Larissa Eienbröker, MSc2, Yves Noel Wu, MSc2, Peter Schily, MD2, Dirk Horenkamp-Sonntag, Dr.3, Katharina Verleger, MA, MPH4, Johann Frick, MSc4, Doerte Huscher, Dr.5, Hanna Winkler, Dr.1, Thomas Reinhold, Prof. Dr.1.
1Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany, 2Emergency and Acute Medicine, Charité University Medicine Berlin, Berlin, Germany, 3Techniker Krankenkasse, Hamburg, Germany, 4Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany, 5Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Berlin, Germany.
1Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany, 2Emergency and Acute Medicine, Charité University Medicine Berlin, Berlin, Germany, 3Techniker Krankenkasse, Hamburg, Germany, 4Institute of Medical Sociology and Rehabilitation Science, Charité University Medicine Berlin, Berlin, Germany, 5Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Berlin, Germany.
OBJECTIVES: In emergency departments (EDs), non-traumatic acute abdominal pain (AAP) is a common and diagnostically challenging complaint, where care remains poorly standardized. The Abdominal Pain Unit (APU) project introduced a standardized care pathway for patients with AAP in EDs in Germany. This study assesses the cost-effectiveness of the APU pathway compared to usual care from the ED perspective.
METHODS: To evaluate the APU pathway, a multicenter, cluster-randomized stepped-wedge trial was conducted from September 2021 to August 2023 in ten EDs. Effectiveness was measured by patient-reported pain, patient satisfaction, and ED length of stay. Resource use was assessed based on the number and costs of abdominal pain-related procedures in the ED, using a standardized pricing catalogue. Group differences were analyzed using mixed-effects models, adjusting for age and triage category and a random center effect. Incremental cost-effectiveness ratios (ICERs) were calculated, with uncertainty assessed through sensitivity analyses.
RESULTS: A total of 2,119 patients were enrolled in the clinical trial (intervention: 1,102; control: 1,017). Patients in the intervention group received more procedures on average (3.0 vs. 2.3), resulting in higher adjusted ED costs per patient (€113 vs. €91; difference: €21; 95% CI: 3.5-37), primarily due to higher proportions of patients receiving ECGs, urine examinations, ultrasounds, and medical councils (intervention vs. control: 63.3% vs. 36.0%; 76.0% vs. 53.8%; 86.3% vs. 71.3%; and 29.7% vs. 22.4%, respectively). With observed improvements in effectiveness outcomes, ICERs were €32 per unit reduction in pain, €14 per unit gain in satisfaction, and €70 per hour reduction in ED length of stay; results were robust in sensitivity analyses.
CONCLUSIONS: The APU process slightly increases resource use in the ED but also improves outcomes. While these findings should be interpreted in the context of the broader trial, they suggest that investing in ED resources may support sustainable APU pathway implementation.
METHODS: To evaluate the APU pathway, a multicenter, cluster-randomized stepped-wedge trial was conducted from September 2021 to August 2023 in ten EDs. Effectiveness was measured by patient-reported pain, patient satisfaction, and ED length of stay. Resource use was assessed based on the number and costs of abdominal pain-related procedures in the ED, using a standardized pricing catalogue. Group differences were analyzed using mixed-effects models, adjusting for age and triage category and a random center effect. Incremental cost-effectiveness ratios (ICERs) were calculated, with uncertainty assessed through sensitivity analyses.
RESULTS: A total of 2,119 patients were enrolled in the clinical trial (intervention: 1,102; control: 1,017). Patients in the intervention group received more procedures on average (3.0 vs. 2.3), resulting in higher adjusted ED costs per patient (€113 vs. €91; difference: €21; 95% CI: 3.5-37), primarily due to higher proportions of patients receiving ECGs, urine examinations, ultrasounds, and medical councils (intervention vs. control: 63.3% vs. 36.0%; 76.0% vs. 53.8%; 86.3% vs. 71.3%; and 29.7% vs. 22.4%, respectively). With observed improvements in effectiveness outcomes, ICERs were €32 per unit reduction in pain, €14 per unit gain in satisfaction, and €70 per hour reduction in ED length of stay; results were robust in sensitivity analyses.
CONCLUSIONS: The APU process slightly increases resource use in the ED but also improves outcomes. While these findings should be interpreted in the context of the broader trial, they suggest that investing in ED resources may support sustainable APU pathway implementation.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE373
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Gastrointestinal Disorders