Cost-Benefit Analysis of Providing Non-Emergency Medical Transportation (2005) / Chapter Skim
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Chapter 7: Condition-Based Cost-Effectiveness Analysis of NEMT and Health This chapter uses the non-emergency medical transportation cost estimates developed in Chapter 5, and the methods elaborated in Chapter 6, to review and analyze the cost-effectiveness of providing NEMT to those who lack access to it, and who suffer from twelve specific medical conditions. Because the benefits of additional care vary according to medical condition, this analysis essentially produces twelve unique costeffectiveness results.
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Step 2. Research cost and benefit parameters.
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of mothers had inadequate prenatal care (Schramm, 1992)
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• Intermediate outcome – intermediate transit cost, mid range for compliance, and a most likely visit count (8)
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commonly accepted as an upper bound cost for an additional life year, the cost for a trip must be less than $16,000. Table 7-4 shows the net costs of NEMT for breast cancer screening.
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Table 7-5: Cost-Effectiveness Results for Colon Cancer Screening Combined Scenario Average Round Trip Cost Visit and Screen Cost (Low Estimate) Visit and Screen Cost (High Estimate)
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dental care is $75 per tooth, the additional cost of providing NEMT does not increase the overall cost of dental care beyond the $50,000 threshold. The cost-effectiveness results are shown in Table 7-6.
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The following calculations rely on this formula: [Compliance factor * (poorly managed cost – well managed cost)
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Table 7-7: Cost Comparison of Asthma Patients in MEPS (2001) Per Capita Population Unweighted Frequency Inpatient Costs ER Costs Outpatient Costs Rx Costs Office Based Cost Total Costs (Mean)
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Table 7-8: Calculation of NEMT Cost for Asthma Trips for Asthma Total Annual Trip Cost Transit Cost Scenario Average Round Trip Cost Visit Cost Fewest Trips Most Trips Low Estimate High Estimate Low $ 42.14 $ 82.62 2 12 $ 249.52 $ 1,497.12 Intermediate $ 43.70 $ 82.62 2 12 $ 252.64 $ 1,515.84 High $ 75.86 $ 82.62 2 12 $ 316.96 $ 1,901.76 Step 8. Incorporate quality of life adjustments so that the analysis will correspond to the QALY methodology.
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Table 7-9: Cost-Effectiveness Results for Asthma NEMT Compliance Factor Poorly minus Well Median Cost per Capita Adjusted Cost Difference Annual Travel & Medical Cost Net Change in Costs QALY Adjustment QALYAdjusted Cost Savings Combined Scenario (1)
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deficiencies addressed. We identify poorly managed patients as those who use neither ACE inhibitors nor beta-blocker medications, and have at least one ER/inpatient stay.
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Table 7-11: Calculation of NEMT Cost for CHF Transit Cost Scenario Average Round Trip Cost Primary Care Visit Cost Specialist Visit Cost Trips for CHF (Primary Care) Trips for CHF (Specialist)
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7.2.3 Chronic Obstructive Pulmonary Disease (COPD) Chronic Obstructive Pulmonary Disease (COPD)
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Step 5. Determine from the literature review how many visits or trips per capita per year are required to manage a patient with COPD.
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7.2.4 Hypertension High blood pressure, or hypertension (HTN) , is highly prevalent and often occurs along with diseases such as diabetes, obesity and heart disease.
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blood pressure (Table 7-17)
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Table 7-18: Calculation of NEMT Cost for HTN Transit Cost Scenario Average Round Trip Cost Primary Care Visit Cost Trips for HTN (Primary Care) Total Trip Cost Low $42.80 $52.68 4 $381.92 Intermediate $44.66 $52.68 4 $389.36 High $86.92 $52.68 4 $558.40 Step 8.
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7.2.5 Diabetes Diabetes is a disorder of the pancreas where the body cannot produce or utilize insulin properly. In the United States, the prevalence of Type 2 diabetes is rising dramatically and many Americans with the disease are unaware that they have it.
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Step 4. Determine the compliance factor(s)
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This highly cost-effective result is nevertheless based on a one-year analysis of the well and poorly managed as defined by the diabetes literature. This likely underestimates the long-term savings associated with better management of diabetes.
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296.2-296.8 (affective psychoses) or 311 (depressive disorder)
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cases that confound the true costs of poorly managed, severely depressed patients. If mildly depressed survey respondents indicate that they have depression, yet do not require and therefore do not receive much medication or many visits to treat their depression, the screen we apply will categorize them as poorly managed, despite the fact that their management is appropriate.
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Table 7-25: Calculation of NEMT Cost for Depression Transit Cost Scenario Average Round Trip Cost Primary Care Visit Cost Specialist Visit Cost Total Trip Cost (Low Estimate= 4 visits to PCP) Total Trip Cost (High Estimate= 8 visits to Specialist)
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Table 7-26: Cost-Effectiveness Results for Depression NEMT Compliance Factor Poorly Minus Well Mean Total Cost per Capita Adjusted Cost Difference Travel & Medical Cost Annual Net Change in Costs QALY Adjustment QALYAdjusted Cost Savings Combined Scenario (1)
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information on whether dialysis was delayed, so categorizing well and poorly managed ESRD patients within MEPS is not possible. Instead, we apply the estimate of cost savings avoided from the literature to the cost of ESRD.
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Table 7-28: Calculation of NEMT Cost for ESRD Transit Cost Scenario Average Round Trip Cost Visit Cost Trips for ESRD (Low Estimate) Trips for ESRD (High Estimate)
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7.3 Summary and Discussion The above sections describe each of 12 cost-effectiveness analyses in detail. In the following sections, we briefly address all 12 at once.
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As described in Chapter 6 and Appendix C, healthcare improvements are worth an investment when the cost is reasonable in light of mortality and morbidity improvements. Thus, while cost savings are clearly the best outcome, the normal expectation is for cost increasing investments that are nevertheless judged to be costeffective.
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