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Difficulty: MediumHealthcare Economics and Value-Based Care

A health system's population health committee is reviewing strategies to reduce 30-day hospital readmissions for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), which currently incur significant financial penalties under the Hospital Readmissions Reduction Program. Under standard discharge planning, the 30-day readmission rate for this population is 22%.

The committee is considering implementing an intensive transitional care program that provides home visits by a respiratory therapist, home delivery of new maintenance inhalers, and a telemedicine follow-up within 48 hours of discharge. A multi-center randomized controlled trial has shown that this program reduces the 30-day readmission rate in this specific population to 17%. The incremental cost to provide this intensive transitional care program is 750 dollars per patient.

Based on the trial data, what is the estimated cost (in dollars) to prevent one 30-day hospital readmission using this transitional care program?

Answer: 15000 dollars

Answer

15000
To determine the cost of preventing a single clinical event (in this case, a 30-day hospital readmission), one must first determine how many patients need to be treated to prevent one event. This metric is the Number Needed to Treat (NNT), calculated as the inverse of the Absolute Risk Reduction (ARR). The ARR is the difference in event rates between standard care and the intervention (0.22−0.17=0.050.22 - 0.17 = 0.05). Thus, NNT=10.05=20NNT = \frac{1}{0.05} = 20. This means 20 patients must receive the transitional care program to prevent one readmission. Since the program costs 750 dollars per patient, treating a cohort of 20 patients will cost 20×750=1500020 \times 750 = 15000 dollars.

Step-by-Step Solution

1
Calculate the Absolute Risk Reduction (ARR).
ARR=0.22−0.17=0.05ARR = 0.22 - 0.17 = 0.05
ARR represents the absolute difference in readmission rates between standard care and the intervention, determining the actual clinical benefit magnitude.
2
Calculate the Number Needed to Treat (NNT).
NNT=10.05=20NNT = \frac{1}{0.05} = 20
The NNT identifies how many patients must receive the transitional care program to prevent exactly one additional hospital readmission.
3
Calculate the cost to prevent one readmission.
20×750=1500020 \times 750 = 15000
Multiplying the NNT (20 patients) by the cost per patient (750 dollars) yields the total financial investment required to prevent one event.

Key Concept

The economic cost to prevent a single adverse health event is calculated by multiplying the Number Needed to Treat (NNT) by the cost of the intervention per patient. NNT is derived as the inverse of the Absolute Risk Reduction (ARR).
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Topics

Healthcare Economics and Value-Based Care

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