Ambulatory care or home-based treatment? An economic evaluation of two physiotherapy delivery options for people with rheumatoid arthritis.
OBJECTIVE
To assess the difference in costs of home-based versus clinic-based physiotherapy (PT) for patients with rheumatoid arthritis (RA) from a societal perspective.


METHODS
A cost analysis was performed using statistical and financial information provided by The Arthritis Society, Ontario Division, from April 1, 1997 to March 30, 1998. Cost estimates included treatment costs and costs borne by patients. A sensitivity analysis was conducted to examine the effect of altering the valuation of treatment time and patient employment status.


RESULTS
Total costs per case were $210.87 for the home setting, and $183.87 for the clinic setting when patients were employed. Sensitivity analysis did not change the trend of the results. The estimated start-up costs for an arthritis clinic were between $302.90 and $652.40. From the perspective of the health care system, these costs would be recovered after serving 4 to 8 RA patients at a clinic.


CONCLUSIONS
The findings suggest that ambulatory PT care is less costly than home-based services for people with RA based on The Arthritis Society model. Further studies should be conducted to examine the effectiveness and the possible adverse consequences of alternative settings for service delivery.
Li
L C
LC
Arthritis & Autoimmunity Research Centre, University Health Network, Consultation and Rehabilitation Service, Arthritis Society, Ontario Division, Toronto, Ontario, Canada.
Coyte
P C
PC
Lineker
S C
SC
Wood
H
H
Renahan
M
M
D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D004651:Employment / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009864:Ontario; D026741:Physical Therapy Modalities / Q000191:economics*; D012680:Sensitivity and Specificity; D013997:Time Factors; D014195:Travel / Q000191:economics