Cost analysis and economic evaluation of a virtual pediatric emergency department pilot program.

OBJECTIVES: The Children's Hospital of Eastern Ontario launched Canada's first virtual pediatric emergency department (ED) from May 2020 through November 2021 to deliver accessible care during the COVID-19 pandemic. The objective of this study was to (i) conduct a cost analysis of the virtual pediatric ED, and (ii) compare the virtual costs to in-person ED costs to inform future resource allocation decisions. METHODS: We calculated costs from a health system perspective in 2021 Canadian dollars. Using a decision tree model, we compared expected costs with and without the virtual pediatric ED, and calculated overall and per patient cost savings of implementing the virtual ED. RESULTS: The virtual ED provided care to 7394 patients. In the base case, virtual care saved $890,000 ($120 per patient). One-way sensitivity analyses suggest overall cost savings were most sensitive to the proportion of virtual care patients who would have received in-person care had the virtual option not been available (range $300,000-$1,700,000), followed by ED overhead costs (range $640,000-$1,140,000). Multivariate sensitivity analyses demonstrated robust cost savings of $920,000 (95% CI 850,000-990,000) in a scenario using billing codes to calculate costs, and savings of $1,040,000 (95% CI 960,000-1,120,000) if physician salaries were used instead. CONCLUSIONS: These findings suggest the virtual pediatric ED reduced costs per patient. Virtual care may represent a financially valuable pediatric emergency department service.

ABSTRAIT: OBJECTIFS: Le Centre hospitalier pour enfants de l'Est de l'Ontario a lancé le premier service d'urgence pédiatrique (SU) virtuel du Canada de mai 2020 à novembre 2021 pour offrir des soins accessibles pendant la pandémie de COVID-19. L'objectif de cette étude est de i) effectuer une analyse des coûts du DE pédiatrique virtuel et ii) comparer les coûts virtuels aux coûts du DE, en personne pour éclairer les décisions futures en matière d'affectation des ressources. MéTHODES: Nous avons calculé les coûts du point de vue du système de santé en dollars canadiens de 2021. À l'aide d'un modèle d'arbre décisionnel, nous avons comparé les coûts prévus avec et sans le service d'urgence pédiatrique virtuel et calculé les économies globales et par patient découlant de la mise en œuvre du service d'urgence virtuel. RéSULTATS: Le service d'urgence virtuel a fourni des soins à 7 394 patients. Dans le cas de base, les soins virtuels ont permis d'économiser 890 000 $ (120 $ par patient). Les analyses de sensibilité unidirectionnelles donnent à penser que les économies de coûts globales étaient plus sensibles à la proportion de patients en soins virtuels qui auraient reçu des soins en personne si l'option virtuelle n'avait pas été disponible (fourchette de 300 000 $ à 1 700 000 $), suivie des frais généraux du SU (fourchette de 640 000 $ à 1 140 000 $). Les analyses de sensibilité à variables multiples ont démontré de solides économies de coûts de 920 000 $ (IC à 95 %, 850 000 à 990 000) dans un scénario utilisant des codes de facturation pour calculer les coûts, et des économies de 1 040 000 $ (IC à 95 %, 960 000 à 1 120 000) si les salaires des médecins étaient utilisés à la place. CONCLUSIONS: Ces résultats suggèrent que le SU pédiatrique virtuel a réduit les coûts par patient. Les soins virtuels peuvent représenter un service d'urgence pédiatrique financièrement utile.

Comparison of allocation strategies of convalescent plasma to reduce excess infections and mortality from SARS-CoV-2 in a US-like population.

BACKGROUND: While the use of convalescent plasma (CP) in the ongoing COVID-19 pandemic has been inconsistent, CP has the potential to reduce excess morbidity and mortality in future pandemics. Given constraints on CP supply, decisions surrounding the allocation of CP must be made. STUDY DESIGN AND METHODS: Using a discrete-time stochastic compartmental model, we simulated implementation of four potential allocation strategies: administering CP to individuals in early hospitalization with COVID-19; administering CP to individuals in outpatient settings; administering CP to hospitalized individuals and administering any remaining CP to outpatient individuals and administering CP in both settings while prioritizing outpatient individuals. We examined the final size of SARS-CoV-2 infections, peak and cumulative hospitalizations, and cumulative deaths under each of the allocation scenarios over a 180-day period. We compared the cost per weighted health benefit under each strategy. RESULTS: Prioritizing administration to patients in early hospitalization, with remaining plasma administered in outpatient settings, resulted in the highest reduction in mortality, averting on average 15% more COVID-19 deaths than administering to hospitalized individuals alone (95% CI [11%-18%]). Prioritizing administration to outpatients, with remaining plasma administered to hospitalized individuals, had the highest percentage of hospitalizations averted (22% [21%-23%] higher than administering to hospitalized individuals alone). DISCUSSION: Convalescent plasma allocation strategy should be determined by the relative priority of averting deaths, infections, or hospitalizations. Under conditions considered, mixed allocation strategies (allocating CP to both outpatient and hospitalized individuals) resulted in a larger percentage of infections and deaths averted than administering CP in a single setting.

Are Unequal Policies in Pre-Exposure Prophylaxis Uptake Needed to Improve Equality? An Examination Among Men Who Have Sex with Men in Los Angeles County.

Racial and ethnic minority men who have sex with men (MSM) are disproportionately affected by HIV/AIDS in Los Angeles County (LAC), an important epicenter in the battle to end HIV. We examine tradeoffs between effectiveness and equality of pre-exposure prophylaxis (PrEP) allocation strategies among different racial and ethnic groups of MSM in LAC and provide a framework for quantitatively evaluating disparities in HIV outcomes. To do this, we developed a microsimulation model of HIV among MSM in LAC using county epidemic surveillance and survey data to capture demographic trends and subgroup-specific partnership patterns, disease progression, patterns of PrEP use, and patterns for viral suppression. We limit analysis to MSM, who bear most of the burden of HIV/AIDS in LAC. We simulated interventions where 3000, 6000, or 9000 PrEP prescriptions are provided annually in addition to current levels, following different allocation scenarios to each racial/ethnic group (Black, Hispanic, or White). We estimated cumulative infections averted and measures of equality, after 15 years (2021-2035), relative to base case (no intervention). By comparing allocation strategies on the health equality impact plane, we find that, of the policies evaluated, targeting PrEP preferentially to Black individuals would result in the largest reductions in incidence and disparities across the equality measures we considered. This result was consistent over a range of PrEP coverage levels, demonstrating that there are "win-win" PrEP allocation strategies that do not require a tradeoff between equality and efficiency.

A Social-Return-On-Investment Analysis Of Bon Secours Hospital's 'Housing For Health' Affordable Housing Program.

Community health programs aimed at addressing the social determinants of health often face challenges demonstrating their impact through traditional economic evaluation methods of return-on-investment analysis, cost-effectiveness analysis, or cost-benefit analysis. Using a social-return-on-investment (SROI) analysis, we evaluated the broader social, environmental, and economic benefits of Bon Secours Hospital's Housing for Health program, an affordable housing program aimed at addressing the social and environmental determinants affecting its community's health in Baltimore, Maryland. Bon Secours currently has 801 units of affordable housing across twelve properties in West Baltimore. Results indicate the significant social value of the Bon Secours affordable housing program, generating between $1.30 and $1.92 of social return in the community for every dollar in yearly operating costs. These findings suggest that broader access to affordable housing could produce a positive social value and demonstrate the relevance of SROI for quantifying the impacts of community health programs.

Longitudinal analysis of dementia diagnosis and specialty care among racially diverse Medicare beneficiaries.

INTRODUCTION: There is insufficient understanding of diagnosis of etiologic dementia subtypes and contact with specialized dementia care among older Americans. METHODS: We quantified dementia diagnoses and subsequent health care over five years by etiologic subtype and physician specialty among Medicare beneficiaries with incident dementia diagnosis in 2008/09 (226,604 persons/714,015 person-years). RESULTS: Eighty-five percent of people were diagnosed by a nondementia specialist physician. Use of dementia specialists within one year (22%) and five years (36%) of diagnosis was low. "Unspecified" dementia diagnosis was common, higher among those diagnosed by nondementia specialists (33.2%) than dementia specialists (21.6%). Half of diagnoses were Alzheimer's disease. DISCUSSION: Ascertainment of etiologic dementia subtype may inform hereditary risk and facilitate financial and care planning. Use of dementia specialty care was low, particularly for Hispanics and Asians, and associated with more detection of etiological subtype. Dementia-related professional development for nonspecialists is urgent given their central role in dementia diagnosis and care.