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Ó Mír M1, Rokicki S2, Lennon O1, O' Toole P3, Desmeules F4, O' Sullivan C1
1University College Dublin, Physiotherapy, Dublin, Ireland, 2University College Dublin, Geary Institute for Public Policy, Dublin, Ireland, 3Our Lady's Children's Hospital, Crumlin, Orthopaedics, Dublin, Ireland, 4University of Montreal, Montreal, Canada
Background: Advanced Practice Physiotherapy (APP) in paediatric orthopaedics is an effective adjunct to traditional consultant-led clinics, improving patient access to outpatient services, and reducing both waiting lists and times, with associated high parental and stakeholder satisfaction ratings. To date, there has been no published economic evaluation of a paediatric orthopaedic APP service
Purpose: The present study evaluates the cost-effectiveness of an APP Clinic in Paediatric Orthopaedics. A comparison of the cost per patient to be seen in the APP clinic versus the orthopaedic consultant elective clinic (OCEC) was performed using a Cost-Benefit Analysis (CBA) to evaluate the impact on the health service
Methods: Data on all patients managed by the APP clinic during one calendar year (2017) were collected and outcomes and associated costs were calculated, including follow-up care as per economic guidelines . These costs were compared to the estimated costs of the usual care pathway, (OCEC), and incremental savings per patient were calculated. A contingent valuation of parental willingness-to-pay (WTP) to attend an APP clinic with wait-time reduction of 21 months , was performed via an online survey of parents, allowing a cost benefit analysis (CBA) to be performed
Results: A total of 534 new patients attended the APP clinic during the year. The unit cost of a new appointment with the APP clinic is €28.31 compared to €55.50 for a new appointment in the OCEC. Our results demonstrate an incremental saving, per patient, of €24.51 in favour of the APP clinic. Sensitivity analysis demonstrates that the cost savings obtained were consistent in all cases, from €23.13 to €29.67 per patient in favour of the APP clinic pathway. This represents a cost saving of 43% for the APP Pathway over that of usual care. A mean WTP of €328 per patient was reported by parents. The CBA demonstrated a marked positive cost differential towards the APP clinic over the OCEC, and a Net Monetary Benefit of €299.69 per patient to the health service provider.
Conclusion(s): This study demonstrates that routine elective paediatric orthopaedic referrals can be successfully managed by an APP in a cost-effective manner. This is the first study to perform an economic analysis of the APP role in paediatric orthopaedics and demonstrates that an APP clinic for non-complex paediatric orthopaedic patients is cost-effective compared to usual care
Implications: Given the ever-increasing demand on paediatric orthopaedic services, new models of care are required to improve access. While all savings reported are specific to local service costings, this study provides a template for local service providers to perform similar economic evaluations, through the establishment of parental WTP. Our group has demonstrated that significant savings can be made by adoption of APP roles in paediatric orthopaedic centres
Keywords: Cost Benefit Analysis, Advanced Practice Physiotherapy, Willingness-to- Pay
Funding acknowledgements: This study was partly funded by the National Children's Research Centre, Dublin.
Purpose: The present study evaluates the cost-effectiveness of an APP Clinic in Paediatric Orthopaedics. A comparison of the cost per patient to be seen in the APP clinic versus the orthopaedic consultant elective clinic (OCEC) was performed using a Cost-Benefit Analysis (CBA) to evaluate the impact on the health service
Methods: Data on all patients managed by the APP clinic during one calendar year (2017) were collected and outcomes and associated costs were calculated, including follow-up care as per economic guidelines . These costs were compared to the estimated costs of the usual care pathway, (OCEC), and incremental savings per patient were calculated. A contingent valuation of parental willingness-to-pay (WTP) to attend an APP clinic with wait-time reduction of 21 months , was performed via an online survey of parents, allowing a cost benefit analysis (CBA) to be performed
Results: A total of 534 new patients attended the APP clinic during the year. The unit cost of a new appointment with the APP clinic is €28.31 compared to €55.50 for a new appointment in the OCEC. Our results demonstrate an incremental saving, per patient, of €24.51 in favour of the APP clinic. Sensitivity analysis demonstrates that the cost savings obtained were consistent in all cases, from €23.13 to €29.67 per patient in favour of the APP clinic pathway. This represents a cost saving of 43% for the APP Pathway over that of usual care. A mean WTP of €328 per patient was reported by parents. The CBA demonstrated a marked positive cost differential towards the APP clinic over the OCEC, and a Net Monetary Benefit of €299.69 per patient to the health service provider.
Conclusion(s): This study demonstrates that routine elective paediatric orthopaedic referrals can be successfully managed by an APP in a cost-effective manner. This is the first study to perform an economic analysis of the APP role in paediatric orthopaedics and demonstrates that an APP clinic for non-complex paediatric orthopaedic patients is cost-effective compared to usual care
Implications: Given the ever-increasing demand on paediatric orthopaedic services, new models of care are required to improve access. While all savings reported are specific to local service costings, this study provides a template for local service providers to perform similar economic evaluations, through the establishment of parental WTP. Our group has demonstrated that significant savings can be made by adoption of APP roles in paediatric orthopaedic centres
Keywords: Cost Benefit Analysis, Advanced Practice Physiotherapy, Willingness-to- Pay
Funding acknowledgements: This study was partly funded by the National Children's Research Centre, Dublin.
Topic: Service delivery/emerging roles; Orthopaedics; Paediatrics
Ethics approval required: Yes
Institution: University College Dublin
Ethics committee: Research Ethics Committee
Ethics number: LS-18-13-OMir-OSullivan
All authors, affiliations and abstracts have been published as submitted.
