Objectives 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. Methods Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0–3 months post-visit) and a Markov model (3–24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED’s pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. Conclusion This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services. 

pdf/integration-of-primary-contact-physiotherapists-in-the-sqdze35fl8.pdf

Integration of primary contact physiotherapists in the emergency department for individuals presenting with minor musculoskeletal disorders: Protocol for an economic evaluation

Objectives: 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. Methods: A randomized clinical trial was conducted among individuals (n=78) aged 18 to 80 years presenting with a musculoskeletal disorder at a Quebec City (Canada) hospital in 2018-2019. Two models of care were compared: management by a physiotherapist and an ED physician versus usual management by an ED physician. Participants follow-ups were conducted at 1 and 3 months post-initial ED visit. Obj.1: The health care costs incurred by the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method and compared using generalized linear models. Obj. 2: The cost-utility analysis over a 3-month time horizon will combine economic and clinical variables (estimated through quality-adjusted life years) using a Societal perspective. The results of the cost-utility analysis will be reported using an ICER. Obj. 3: The ICER will be estimated using a hybrid decision tree (0-3 months post-visit) and Markov model (3-24 months post-visit); the analysis will be conducted from a Societal perspective over a two-year time horizon. Conclusion: This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services.

/pdf/integration-of-primary-contact-physiotherapists-in-the-fj7lg9to.pdf

OBJECTIVE: To evaluate the cost-utility of a single session compared with multiple sessions of physical therapy care for adults with spinal disorders. DESIGN: Economic evaluation based on a pragmatic randomized controlled trial. METHODS: Patients with spinal disorders who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physical therapist were randomized to either a single session of education and exercise prescription (n = 52) or multiple sessions (6 sessions) of a multimodal physical therapy intervention (n = 54). Patients answered questionnaires on the health care resources used and related costs, as well as the EuroQol 5-dimension 5-level questionnaire at baseline and at 6, 12, and 26 weeks. Total health care costs and quality-adjusted life years (QALYs) were calculated. A cost-utility analysis comparing both groups was conducted using an intention-to-treat approach with multiple imputation to handle missing data. Nonparametric bootstrapping with 1000 resamples was performed. The incremental cost-effectiveness ratio (ICER) was subsequently calculated. Sensitivity analyses were performed. RESULTS: Compared to the single-session group, the multiple-session group incurred a significantly higher total health care costs of CA$368 (95% confidence interval [CI], $327 to $412) and achieved an additional 0.013 QALY (95% CI, 0.009 to 0.018). The ICER for the multiple-session approach was CA$29 787 per QALY gained compared to the single-session approach. Excluding private costs leads to similar results, while the complete-case analysis suggested that the multiple-session approach was not cost-effective. CONCLUSION: A multiple-session approach may be considered cost-effective compared to a single session of physical therapy for adults with spinal disorders in an advanced practice physical therapy model of care. J Orthop Sports Phys Ther 2025;55(11):719-726. Epub 29 September 2025. doi:10.2519/jospt.2025.13468 

Cost-Effectiveness of Single Versus Multiple Sessions of Physical Therapy for Adults With Spinal Disorders: An Economic Evaluation From a Pragmatic Randomized Controlled Trial

<sec> <title>BACKGROUND</title> The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. </sec> <sec> <title>OBJECTIVE</title> To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. </sec> <sec> <title>METHODS</title> We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). </sec> <sec> <title>RESULTS</title> The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. </sec> <sec> <title>CONCLUSIONS</title> While the benefits of PPE use are likely to diminish as health care workers’ immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. </sec> <sec> <title>CLINICALTRIAL</title> PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598 </sec> <sec> <title>INTERNATIONAL REGISTERED REPORT</title> DERR1-10.2196/50682 </sec> 

pdf/post-pandemic-evaluation-of-the-eco-efficiency-of-personal-41qdhe0zdr.pdf

Post-pandemic evaluation of the eco-efficiency of personal protective equipment against COVID-19 in emergency departments: a mixed method study protocol (Preprint)

OBJECTIVE
To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases.


DESIGN
A retrospective cohort study.


SETTING
This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays.


PARTICIPANTS
Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma.


MAIN OUTCOME MEASURES
The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients.


RESULTS
We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)).


CONCLUSIONS
The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.

Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada.

The aim of this study was: (1) to adapt the time‐driven activity‐based costing (TDABC) method to emergency department (ED) ambulatory care; (2) to estimate the cost of care associated with frequently encountered ambulatory conditions; and (3) to compare costs calculated using estimated time and objectively measured time.

Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department

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Adaptation of time‐driven activity‐based costing to the evaluation of the efficiency of ambulatory care provided in the emergency department