157 Budget impact analysis of Holter monitors provision in an outpatient clinic

Abstract

Abstract Background Outpatient clinic attendees (aged >64) commonly present with falls, dizziness, syncope and palpitations. The most common non-invasive investigation ordered includes continuous ambulatory electrocardiography monitoring, namely the Holter monitor. The clinic is outsourcing Holter monitor requests to the Cardiology Department, with a long waiting list. If the patient wishes the test to be done sooner in a private hospital, it costs between 160 to 295 euros, covered by the patient’s private healthcare insurance. Methods A budget analysis was carried out to further evaluate by provisioning 5 Holter monitors in the outpatient clinic to quicken patient turnover and reduce the cardiology department waiting list. The intervention scope was limited to the designated clinic of approximately 450 patients a month. The intervention is not for generating revenue for the clinic. The budget analysis doesn’t include sensitivity analysis from the best-case towards worst-case scenarios of Holter frequency usage and duration of Holter monitoring. The objectives of the proposed change are to lessen the turnaround time by 20% for the patients from being assessed until discharge from the clinic without having delayed investigation of the Holter monitor, to have a timely and accurate diagnosis of suspected arrhythmia and the appropriate management within the new intervention. Results The decision tree, utilising the Decision analytic modelling, resource identification, cost implication, estimated changes including 2-hour staff training, capital, year one to year five costs, potential cost savings year-on-year, cost-per-wear comparison against the private hospital provider, pre and post-intervention scenario analysis were constructed. Conclusion The budget impact analysis designed a simple cost calculator to add additional tests of Holter monitors that rely on the decision model approach. It shows a potential cost saving within a five-year horizon and increases the number of patients’ attendance by optimising patient turnover. Apart from the cost and organisation, there are other positive impacts towards financial and clinical areas, ensuring high-quality service for the population.