Table 2. Cost analysis for nursing phone care and academic detailing
Cost AreaCost DetailCost Estimate Calculations
Cost savings for nursing phone care per year*
    ARI-related clinic visitsVisits avoided (21 months)1983
Visits avoided per year (95% CI for sensitivity analysis)1,133 (1,101, 1,159)
Avoided visit average cost$133
Estimate avoided clinic visit costs per year (range in sensitivity analysis from 95% CI of visits avoided)$150,708 ($146,433, $154,147)
    AntibioticsAntibiotics avoided per year through nursing phone care1133 × 0.56§ = 635
Average cost of antibiotic$9.61
Estimate avoided cost per year (range from 95% CI of visits avoided above)$6,098 ($5,925, $6,237)
    Total (range in sensitivity analysis)Costs avoided$156,806 ($152,358, $160,384)
Cost savings for academic detailing per year*
    AntibioticsAntibiotics avoided per year through academic detailing (number of ARI visits × difference in antibiotic rate before and after intervention)13,584 × 16.5%=2,241
Sensitivity analysis on antibiotics avoided from 95% CI for difference in antibiotic rate (from text)13,584 × 12.5%=1,698
13,584 × 20.5%=2,785
Average cost of antibiotic$9.61
    Total (range in sensitivity analysis)Antibiotic costs avoided$21,539 ($16,317, $26,763)
Cost for academic detailing
    Start-up costsTraining (2-day course on academic detailing, including tuition, lodging, salary, and travel for physician and pharmacist one-time cost, amortized)$4,391
    Annual costsBenchmark data computer program development (8 hours per year)$438
Preparation and presentation of academic detailing to providers (yearly cost: 32 hours for physician, 50 hours for pharmacist)$13,265
Provider cost to receive detailing per year (2 hours per provider (70 ± 9 providers) with 24 receiving an additional hour)$17,098 ($15,220, $18,975)
    Total per year (including amortized start-up costs)$35,192 ($33,315, $37,069)
Cost expenditures for nursing phone care per year
    Nurse-provided phone careTwo nurse salaries per year$161,680
Percent of phone care for ARI (95% CI)46.8% (45.7%, 47.8%)
Total (range in sensitivity analysis)Estimate added cost per year$75,666 ($73,888, $77,283)
Total savings to health care payers per year*
Cost savings from visits avoided (from above)$156,806 ($152,358, $160,384)
Antibiotic costs avoided (from above)$21,539 ($16,317, $26,763)
Overall annual savings at Virginia Mason (range in sensitivity analysis)$178,345 ($168,675, $187,147)
Annual savings per 1,000 episodes of ARI at Virginia Mason (range in sensitivity analysis)$13,129 ($12,417, $13,777))
Total cost to delivery system per year
Nursing phone care costs (from above)$75,666 ($73,888, $77,283)
Academic detailing costs (from above)$35,192 ($33,315, $37,069)
Total costs$110,858 ($107,203, $114,352)
Total savings to health care payers per year if nurse care and academic detailing were reimbursed$67,487 ($54,323, $79,944)
  • * Cost analysis from the payer perspective.

  • Cost analysis from the healthcare delivery perspective.

  • Number of patients with nurse phone care without subsequent provider visit.

  • § Baseline rate of antibiotic use.

  • Values represent estimated cost savings and expenditures.

  • ARI, acute respiratory illness; CI, confidence interval.