Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases

  • Carmen Sanclemente-Ansó
    Correspondence
    Corresponding author at: Bellvitge University Hospital, Consultas Externas, Area de Gestión Administrativa, c/Feixa Llarga s/n 08907-L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. Tel.: +34 932608335; fax: +34 932607672.
    Affiliations
    Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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  • Xavier Bosch
    Affiliations
    Department of Internal Medicine, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques Auguts Pi i Sunyer, Barcelona, Catalonia, Spain
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  • Albert Salazar
    Affiliations
    Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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  • Ramón Moreno
    Affiliations
    Department of Economic Development, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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  • Cristina Capdevila
    Affiliations
    Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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  • Beatriz Rosón
    Affiliations
    Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
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  • Xavier Corbella
    Affiliations
    Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain

    Albert J. Jovell Institute of Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Catalonia, Spain
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Published:March 01, 2016DOI:https://doi.org/10.1016/j.ejim.2015.12.015

      Highlights

      • Full economic evaluation studies of quick diagnosis units (QDUs) are lacking.
      • There were notable cost savings from hospitalization in anemia and cancer patients.
      • Main health outcomes of QDU and hospitalization by cost-minimization were equivalent.
      • Highest QDU savings corresponded to fixed costs of hospital stays (66% of savings).
      • QDU savings from structural/general functioning costs of hospitalization were 33%.

      Abstract

      Background

      Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported.

      Aims

      To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent.

      Methods

      Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared.

      Results

      Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31.

      Conclusion

      QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere.

      Keywords

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