title: Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.
abstract: BACKGROUND
  Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported.
  
  
  OBJECTIVE
  To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent.
  
  
  METHODS
  Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared.
  
  
  RESULTS
  Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31.
  
  
  CONCLUSIONS
  QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere.
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. Electronic address: csanclemente@bellvitgehospital.cat.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sanclemente-Ansó
authors.affiliation: Department of Internal Medicine, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques Auguts Pi i Sunyer, Barcelona, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.affiliation: Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Salazar
authors.affiliation: Department of Economic Development, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Emergency Department, Bellvitge University Hospital, Department of Medicine, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Capdevila
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rosón
authors.affiliation: Department of Internal Medicine, Bellvitge University Hospital, University of Barcelona, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Albert J. Jovell Institute of Public Health and Patients, Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Corbella
mesh_terms: D000740:Anemia / Q000175:diagnosis*; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis*; D010045:Outpatients; D017060:Patient Satisfaction; D013030:Spain
keywords: Conventional hospitalization; Cost-minimization analysis; Costs savings; Quick diagnosis units