Saving Money Improving Outcomes: A Two-Year Cost-Utility Analysis of Emergency Department Care Models for Managing Persons Presenting With a Musculoskeletal Disorder
Author(s)
Rose Gagnon, MPT, MSc, PhD(c)1, Naomi Hope Chouinard, MSc1, Kadija Perreault, PT, PhD1, Simon LaRue, MSc2, Simon Berthelot, MSc, MD1, Juliette Marchand, BSc1, Komi Edem Gatovo, MSc2, Luc J. Hébert, Fellow PT, PhD, CD1, Jason Robert Guertin, PhD1.
1Université Laval, Quebec City, QC, Canada, 2CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada.
1Université Laval, Quebec City, QC, Canada, 2CHU de Québec - Université Laval Research Centre, Quebec City, QC, Canada.
OBJECTIVES: As access to primary healthcare remains challenging, numerous persons presenting a musculoskeletal disorder (MSKD) will visit the emergency department (ED) to receive care. However, no study has evaluated the impact of care models used to manage MSKDs beyond three months. We thus evaluated the two-year efficiency of two ED care models: 1) management by an emergency physician (EP), and 2) management by a physiotherapist (PT) and an EP.
METHODS: Two-year cost-utility analysis using a hybrid mathematical model (decision tree + Markov model), from two perspectives: Public Payer and Canadian Society. The decision tree part, 0-3 months, was based on data collected during a randomized clinical trial (n=78, aged 18-80, #NCT04009369). Health-related quality of life was measured using the ED-5D-5L; utility scores were converted into quality-adjusted life years (QALY). Costs were measured using a standardized resource utilization questionnaire. The remaining 21 months were modeled using data from the literature. A probabilistic approach was used to ensure the results’ robustness (Monte Carlo simulation, n=10,000 iterations). All costs were reported in CAD 2024 values.
RESULTS: After two years, the average cost per patient for participants managed by the PT + EP was $6,164 for the Public Payer and $30,896 for Society, compared with $6,851 and $47,260 for EP management. Mean QALY gain for the PT + EP group was 1.57, and 1.47 for the EP group. Management by a PT + EP proved dominant under both perspectives. In both cases, the proportion of iterations in which the new care model was dominant was over 80%.
CONCLUSIONS: Participants managed by a PT + EP showed a better quality of life after two years, with lower healthcare costs. Integrating PTs in EDs could result in long-term savings for the Public Payer and the Canadian Society, while also helping to improve patients’ clinical outcomes.
METHODS: Two-year cost-utility analysis using a hybrid mathematical model (decision tree + Markov model), from two perspectives: Public Payer and Canadian Society. The decision tree part, 0-3 months, was based on data collected during a randomized clinical trial (n=78, aged 18-80, #NCT04009369). Health-related quality of life was measured using the ED-5D-5L; utility scores were converted into quality-adjusted life years (QALY). Costs were measured using a standardized resource utilization questionnaire. The remaining 21 months were modeled using data from the literature. A probabilistic approach was used to ensure the results’ robustness (Monte Carlo simulation, n=10,000 iterations). All costs were reported in CAD 2024 values.
RESULTS: After two years, the average cost per patient for participants managed by the PT + EP was $6,164 for the Public Payer and $30,896 for Society, compared with $6,851 and $47,260 for EP management. Mean QALY gain for the PT + EP group was 1.57, and 1.47 for the EP group. Management by a PT + EP proved dominant under both perspectives. In both cases, the proportion of iterations in which the new care model was dominant was over 80%.
CONCLUSIONS: Participants managed by a PT + EP showed a better quality of life after two years, with lower healthcare costs. Integrating PTs in EDs could result in long-term savings for the Public Payer and the Canadian Society, while also helping to improve patients’ clinical outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE655
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)