| Cost Area | Cost Detail | ‖Cost Estimate Calculations |
|---|---|---|
| Cost savings for nursing phone care per year* | ||
| ARI-related clinic visits | Visits 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) | |
| Antibiotics | Antibiotics avoided per year through nursing phone care | 1133 × 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* | ||
| Antibiotics | Antibiotics 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 costs | Training (2-day course on academic detailing, including tuition, lodging, salary, and travel for physician and pharmacist one-time cost, amortized) | $4,391 |
| Annual costs | Benchmark 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 care | Two 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.