Objectives: Compare the average cost of an emergency department (ED) visit between three ED care models, namely management by an emergency physician (EP) alone (usual care), management by a primary contact physiotherapist (PT) and an EP (intervention), and management by a PT alone (sensitivity analysis). Methods: Cost study (Canadian Public Payer perspective) based on data collected during a pragmatic randomized clinical trial (2018-2019) conducted in an urban Canadian academic ED (CHUL, Quebec City, Canada; n=78, 18-80 years old). Costs incurred for the management of persons presenting to the ED for a minor musculoskeletal disorder (MSKD) were calculated using Time-Driven Activity-Based Costing, in which time invested with a patient determines care costs. The main outcome measure was the average cost of an ED visit. Generalized linear models with Gamma distributions and log links were used to assess whether there were significant differences in average costs between the care models. Results: Mean ED visit cost was $278.47 (2019 $CAD, 95%CI: $223.70, $357.42) for PT and EP management, compared with $254.68 for EP management ($178.48, $346.68), resulting in a non-significant absolute difference of 23.79 CAD/patient ($-87.04, $135.74) between models (p=.58). Sensitivity analyses showed that the average cost of ED management by a PT was $194.40 ($160.86, $235.14), representing a non-significant average saving of 60.28 CAD/patient ($-168.19, $31.46) compared to EP management. Conclusion: This study is a first step towards a better understanding of the costs incurred by the Canadian Public Payer for the management of persons presenting with MSKDs in the ED. Primary contact physiotherapists have the potential to complement care of MSKD ED patients without increasing healthcare costs.

The authors have declared no competing interest.

NCT04009369

https://doi.org/10.1371/journal.pone.0277369

Part of the data that were used in this study were acquired during a randomized clinical trial supported by the CHU de Quebec Universite Laval, subsidies from LJH and KP, and a clinical research scholarship awarded to one of the CHU de Quebec collaborators by the Fondation du CHU de Quebec for the multidisciplinary council of the CHU de Quebec Universite Laval. RG received scholarships from the Canadian Institutes of Health Research (CIHR), the Fonds de recherche Quebec Sante (FRQ-S), the Unite de soutien SSA Quebec, the Ordre professionnel de la physiotherapie du Quebec, the Centre interdisciplinaire de recherche en readaptation et integration sociale (Cirris) and Universite Laval. SB and JRG are FRQ-S Research Scholars. The funding organizations had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of CHU de Quebec - Universite Laval gave ethical approval for this work (#MP-20-2019-4307)

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All data produced in the present study are available upon reasonable request to the authors.