Pediatric Radiology

, Volume 35, Issue 12, pp 1186–1195

Cost-effectiveness analysis of weekday and weeknight or weekend shifts for assessment of appendicitis

  • Andrea S. Doria
  • Heidi Amernic
  • Paul Dick
  • Paul Babyn
  • Peter Chait
  • Jacob Langer
  • Peter C. Coyte
  • Wendy J. Ungar
Original Article

DOI: 10.1007/s00247-005-1570-z

Cite this article as:
Doria, A.S., Amernic, H., Dick, P. et al. Pediatr Radiol (2005) 35: 1186. doi:10.1007/s00247-005-1570-z

Abstract

Background: Assessment of appendicitis during a weeknight or weekend shift (after-hours period, AHP) might be more costly and less effective than its assessment on a weekday shift (standard hours period, SHP) because of increased costs (staff premium fees) and perforation risk (longer delays and less experience of fellows). Objectives: The objectives were to compare the costs and effectiveness of assessing children with suspected appendicitis who required a laparotomy and had US or CT after-hours with those of assessing children during standard hours, and to evaluate the importance of diagnostic imaging (DI) within the overall costs. Materials and methods: We retrospectively microcosted resource use within six areas of a tertiary hospital (emergency [ED], diagnostic imaging (DI), surgery, wards, transport, and pathology) in a tertiary hospital. About 41 children (1.8–17 years) in the AHP and 35 (2.9–16 years) in the SHP were evaluated. Work shift effectiveness was measured with a histological score that assessed the severity of appendicitis (non-perforated appendicitis: scores 1–3; perforated appendicitis: score 4). Results: The SHP was less costly and more effective regardless of whether the calculation included US or CT costs only. For a salary-based fee schedule, US$733 were saved per case of perforated appendicitis averted in the SHP. For a fee-for-service payment schedule, $847 were saved. Within the overall budget, the highest costs were those incurred on the ward for both shifts. The average cost per patient in DI ranged from 2 to 5% of the total costs in both shifts. Most perforation cases were found in the AHP (31.7%, AHP vs. 17.1%, SHP), which resulted in higher ward costs for patients in the AHP. Conclusion: A higher proportion of severe cases was seen in the AHP, which led to its higher costs. As a result, the SHP dominated the AHP, being less costly and more effective regardless of the fee schedule applied. The DI costs contributed little to the overall cost of the assessment of appendicitis.

Keywords

Cost-effectiveness analysis Appendicitis Children Salary-based schedule Fee-for-service schedule 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Andrea S. Doria
    • 1
  • Heidi Amernic
    • 2
  • Paul Dick
    • 3
  • Paul Babyn
    • 1
  • Peter Chait
    • 1
  • Jacob Langer
    • 4
  • Peter C. Coyte
    • 2
  • Wendy J. Ungar
    • 5
  1. 1.Department of Diagnostic ImagingHospital for Sick ChildrenTorontoCanada
  2. 2.Department of Health Policy and Management EvaluationUniversity of TorontoTorontoCanada
  3. 3.Paediatric Emergency Medicine, Population Health SciencesHospital for Sick ChildrenTorontoCanada
  4. 4.Department of General SurgeryHospital for Sick ChildrenTorontoCanada
  5. 5.Population Health Sciences, The Hospital for Sick Children, Department of Health Policy and Management EvaluationUniversity of TorontoTorontoCanada