title: Cost-effectiveness analysis of weekday and weeknight or weekend shifts for assessment of appendicitis.
abstract: BACKGROUND
  Assessment of appendicitis during a weeknight or weekend shift (after-hours period, AHP) might be more costly and less effective than its assessment on a weekday shift (standard hours period, SHP) because of increased costs (staff premium fees) and perforation risk (longer delays and less experience of fellows).
  
  
  OBJECTIVE
  The objectives were to compare the costs and effectiveness of assessing children with suspected appendicitis who required a laparotomy and had US or CT after-hours with those of assessing children during standard hours, and to evaluate the importance of diagnostic imaging (DI) within the overall costs.
  
  
  METHODS
  We retrospectively microcosted resource use within six areas of a tertiary hospital (emergency [ED], diagnostic imaging (DI), surgery, wards, transport, and pathology) in a tertiary hospital. About 41 children (1.8-17 years) in the AHP and 35 (2.9-16 years) in the SHP were evaluated. Work shift effectiveness was measured with a histological score that assessed the severity of appendicitis (non-perforated appendicitis: scores 1-3; perforated appendicitis: score 4).
  
  
  RESULTS
  The SHP was less costly and more effective regardless of whether the calculation included US or CT costs only. For a salary-based fee schedule, 733 US dollars were saved per case of perforated appendicitis averted in the SHP. For a fee-for-service payment schedule, 847 dollars were saved. Within the overall budget, the highest costs were those incurred on the ward for both shifts. The average cost per patient in DI ranged from 2 to 5% of the total costs in both shifts. Most perforation cases were found in the AHP (31.7%, AHP vs. 17.1%, SHP), which resulted in higher ward costs for patients in the AHP.
  
  
  CONCLUSIONS
  A higher proportion of severe cases was seen in the AHP, which led to its higher costs. As a result, the SHP dominated the AHP, being less costly and more effective regardless of the fee schedule applied. The DI costs contributed little to the overall cost of the assessment of appendicitis.
authors.affiliation: Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G 1X8. andrea.doria@sickkids.ca
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Doria
authors.forename: Heidi
authors.initials: H
authors.lastname: Amernic
authors.forename: Paul
authors.initials: P
authors.lastname: Dick
authors.forename: Paul
authors.initials: P
authors.lastname: Babyn
authors.forename: Peter
authors.initials: P
authors.lastname: Chait
authors.forename: Jacob
authors.initials: J
authors.lastname: Langer
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Ungar
mesh_terms: D000293:Adolescent; D039602:After-Hours Care / Q000191:economics; D001064:Appendicitis / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003362:Cost-Benefit Analysis; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics; D018084:Ultrasonography, Interventional / Q000191:economics; D014481:United States; D014940:Work Schedule Tolerance