Could Primary Contact Physiotherapy Improve Emergency Department Care While Being Efficient? A Three-Month Cost-Utility Analysis

OBJECTIVE: To evaluate the cost-utility of two emergency department (ED) care models: management by an emergency physician (EP, usual care), and management by a primary contact physiotherapist (PT) and an EP (PT-EP, intervention). DESIGN: Cost-utility analysis based on data collected during a pilot pragmatic randomized clinical trial over a 3-month period (NCT04009369). METHODS: We measured health-related quality of life (HRQoL) and health resource use at baseline, and 1 and 3 months, using the EQ-5D-5L and a standardized healthcare resource use questionnaire. Responses to the EQ-5D-5L were transformed into utility scores (Canadian conversion algorithm), and then into quality-adjusted life years (QALY) using area-under-the-curve analyses. Costs and QALYs were used to derive incremental cost-effectiveness ratios for each perspective. We conducted a complete case analysis (main analysis), and missing data were imputed using multiple imputation (sensitivity analysis). RESULTS: After 3 months, participants managed by the PT-EP had a QALY gain of 0.195 (95% Confidence Interval (95%CI): 0.179-0.209), compared to 0.182 (95%CI: 0.168-0.195) for those managed by the EP alone. The average total cost in the PT-EP group for the public payer was $469.23/patient (95%CI: $269.30-$708.85) and $878.37/patient for society (95%CI: $559.72-$1,208.23), compared with $804.70/patient (95%CI: $225.58-$1,972.78) and $1,288.76/patient (95%CI: $551.84-$2,452.48) respectively in the EP group [2019 CAD]. PT-EP management was dominant for the public payer and Canadian society perspectives. CONCLUSION: The addition of PTs in EDs may reduce expenses for the public payer and society, while improving HRQoL.