OBJECTIVE: In the United States, there are gaps in patients’ ability to access primary care facilities in a timely manner. As a result, emergency departments (EDs) are reported to be operating beyond capacity. Simultaneously, urgent care center (UCC) capacity continues to increase annually. This study examined the cost-effectiveness of EDs compared to UCCs for four non-emergent conditions that are commonly presented by Medicare participants: upper respiratory infections, urinary tract infections (UTI), sprains and strains, and contusions.

METHODS: ED visits, hospitalization rates and discharges were obtained from the 2018 Healthcare Cost and Utilization Project. Evaluation and monitoring (E/M) and facility costs were derived from the CMS Medicare Physician Fee Schedule, while the percentage of unnecessary ED visits was determined through the Billings algorithm. The difference between the costs of an ED and a UCC visit followed by hospitalization was used as a measure of incremental costs. For incremental effectiveness, the discrepancy of being discharged from the ED compared to a UCC was determined. Uncertainty was tested through a one-way sensitivity analysis with a ±25% variation in costs and a ±10% variation in outcomes. A probabilistic sensitivity analysis (PSA) was performed using a gamma distribution for costs and a beta distribution for outcomes over 300 iterations.

RESULTS: The cost-effectiveness analysis produced favorable ICERs for UCCs compared to EDs. The one-way sensitivity analysis showed a 16.7% reduction and a 13.6% increase in the ICER with the lower and upper variations, respectively. The PSA results indicated 87.3%, 99.3%, 97.3% and 92% of the model iterations were cost effective for respiratory, UTI, sprains/strains and contusions, respectively, upon incorporation of a WTP threshold.

CONCLUSION: UCCs can cost-effectively fill the void of backlogged primary and low to mid-acuity emergency needs. This benefit can be tapped through the integration of UCCs in the mainstream healthcare system.