Studies of cost-effectiveness
| Study details and country | Design | Control | Intervention | Results |
|---|---|---|---|---|
| Murphy et al12 Ireland 1996 | RCT All new patients attending classified as semi-urgent or delay acceptable | N=2381 usual care | N=2303 sessional GPs | For all patients seen by GPs during the study, estimated marginal and total savings were £1427 and £117 005, respectively. (£95 125 with GP salary) |
| Dale et al23 England 1996 | Quasi-randomised Nurse triage—allocate patients to primary care or ED n=419, 3 h sessions (10:00–13:00; 14:00–17:00; 18:00–21:00) | n=2382 managed by ED SHO n=557 managed by ED registrars n=204 ED doctor sessions | n=1702 managed by sessional GPs n=215 GP sessions | Cost per patient SHO—£19.30 Registrar—£17.97 GP—£11.70 Follow-up costs not explicit but 23% contacted their own GP at least once for the same condition Patients that had seen by a GP in the ED made more visits to own GP, underwent more subsequent investigations and were referred more |
| Jiménez et al18 Spain 2005 | Prospective Before and after study. Adult and paediatric patients triaged to fast-track area | N=100 Resident physicians, 08:00–24:00 | N=100 GP resident in fast-track area for 8 h 16:00–24:00 | Cost-effectiveness analysis clearly supported the study period, showing a decrease in CE indices for WTs, opening times and perceived WT (55% less, 95% CI −100 to −11) (33% less; −60 to −11) and (6% less; –42 to –48), respectively Cost/visit €237 intervention, €300 control Variable costs (€930 to €1440) Fixed costs (€5118 to €4510) |
| Van Uden et al24 Netherlands 2006 | Economic analysis and before and after comparison | Stand-alone ED and GPC | Integrated ED and GPC | Per capita costs of the integrated model were higher (€11.47 and €10.54, respectively) ED costs were constant; however, a loss of €1.36 million was realised due to reduced activity |
| Salisbury et al7 England 2007 | Before and after Random sample over a 2-week period | N=200 8 traditional/stand-alone EDs | N=200 8 EDs with co-located walk-in centres | No change in overall cost per patient (−£3.06; 95% CI −16.50 to 10.39) or for admitted patients (−£20.97; 95% CI −64.98 to 23.04 per patient) The year-on-year total cost increased by 22% in the intervention group and by 10% in the control group The differential between the two groups was largely due to the difference in the increase in clinical staff costs of 28% in the intervention group and 15% in the control group |
| Bosmans et al25 Netherlands 2012 | Before and after intervention Self-referrers who attended the ED on weekdays (10:00–17:00) | n=832 Standard ED care | N=695 Allocated to GP (additional resource) | Total mean costs per patient in the new care (GP) period were lower than in the usual care period (mean difference −€71, 95% CI −121 to −23) Medical costs were the largest contributor to this difference in total costs (mean difference −€68, 96% of total cost difference) Process time costs in the new care period were significantly lower than in the usual care period (mean difference −€4, 95% CI −4 to −3) Diagnostics −€10 (−21 to 1) Therapeutic −€39 (−81 to −6) |
GPs, general practitioners; GPC, GP collaboratives; RCT, randomised controlled trial; SHO, senior house officer; WT, waiting time.