Economic evaluation of the hospitalist care model in an acute medical unit: a benefit–cost analysis

Abstract

Objective This study aimed to assess the economic efficiency of the acute medical unit (AMU) hospitalist care model, utilising patient outcomes (length of hospital stay, emergency department (ED)-length of hospital stay, in-hospital mortality) from a previous investigation.Design A retrospective cohort study was conducted using benefit–cost analysis from a societal perspective. Data relating to clinical factors, outcomes and medical costs were obtained from the electronic medical record database at our institution. Literature-based costing was applied to determine direct non-medical costs and indirect costs that could not be obtained directly.Setting A tertiary care hospital in the Republic of Korea.Participants We evaluated 6391 medical inpatients admitted through the ED from 1 June 2016 to 31 May 2017.Interventions The study compared multiple types of costs and benefits among inpatients from the ED between a non-hospitalist group and an AMU hospitalist group.ResultsThis investigation found a significant reduction in medical costs and total costs in the AMU hospitalist group compared to the non-hospitalist group (30% reduction, 95% CI: 27.6–32.1%, P=0.000; 29.3% reduction, 95% CI: 27.0–31.5%, P=0.000; respectively). Furthermore, significant reductions in direct and indirect costs were found in the AMU hospitalist group compared to the non-hospitalist group (28.6% reduction, 95% CI: 26.6–30.5%, P=0.000; 23.3% reduction, 95% CI: 20.9–25.5%, P=0.000; respectively). The net-benefit and benefit-cost ratio (BCR) of the AMU hospitalist care group were US $6846 and 1.33 per patient admission, respectively.Conclusions The AMU hospitalist care model was associated with remarkable reductions in multiple costs. The results of the sensitivity analysis indicated that the net-benefit estimates of AMU hospitalist care were similar to the baseline estimates. Thus, the overall net-benefit of AMU hospitalist care was found to be largely positive.