The Pharmacoeconomics of Managing Acute Agitation in the Emergency Department

What Do We Know and How Do We Approach It?

Esther W Chan; David McD Taylor; Jonathan C Knott; Danny Liew; David CM Kong


Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(5):589-595. 

In This Article

Sources of Cost Data

Direct medical costs, including those associated with drug acquisition, investigations (i.e., pathology and imaging), monitoring (i.e., electrocardiogram) and staff time, should be included in the model. Cost data may be obtained from local or national institutional sources or from the published literature, as appropriate. Drug acquisition costs can be obtained as wholesale prices as paid by Australian public hospitals (e.g., as based on the Australian Hospital Purchasing Victoria tender[104]). Costs of pathology, imaging and monitoring tests can be obtained from sources including the Medical Benefits Schedule.[105] Where possible, relevant proxies should be considered for intense resource utilization for the management of acute agitation in the ED. For example, management may involve the use of patient seclusion and restraints and the use of one-to-one 24-h nursing care/observations. The wages for specialized staff may be used in this instance.

Institutional 'general ledger ED expenditure figures' may be available from decision-support units, used as a source of hospitalization costs. The Australian-Refined Diagnosis Related Group assignment relating to mental health presentations may be used to select for the hospitalization expenditure figures that are relevant to the ED. While such figures may be available, these dollar expenditure data may not necessarily enable the separation of medical and nonmedical costs among the multiple items comprising hospitalization.

It should be noted that different countries will have different and additional sources for cost data. For example, in the USA, the Wholesale Acquisition Cost may be an important source of data. Furthermore, many large institutions may have group discounts that should be accounted for in the analysis.