Healthcare Cost Associated with an Acute Mental Healthcare Bundle in Pediatric Emergency Departments

OBJECTIVE: To evaluate healthcare cost associated with a standardized mental healthcare bundle in two tertiary pediatric emergency departments (EDs) in Alberta, Canada. METHODS: We linked data from the two EDs and administrative health databases. Patients < 18 years presenting with mental health concerns were enrolled during two periods: pre-implementation (standard care) and implementation (mental health bundle). Healthcare resource utilization (HCRU) and costs were compared over 12 months following the initial ED visit. RESULTS: The study included 686 pre-implementation (mean age 12.6 years) and 692 implementation (mean age 13.0 years) patients with similar sex distribution (p = 0.65). Implementation patients had lower admission rates at the index ED visit (4.6% versus 9.8%; p < 0.001). During 1 year of follow-up, implementation patients had fewer hospitalizations (mean = 0.4 versus 0.5; p < 0.001), non-ED ambulatory care visits (mean = 2.7 versus 10.0; p < 0.001), and practitioner claims (mean = 34.3 versus 46.8; p = 0.001). Implementation patients had lower healthcare costs ($12,408 [95% CI $10,336-$14,479] versus $19,326 [95% CI $16,596-$22,056]; p < 0.001) attributable to lower hospitalization ($6845 [95% CI $5257-$8435] versus $9994 [95% CI $8205-$11,782]; p = 0.01), ambulatory care ($1711 [95% CI $1383-$2038] versus $4027 [95% CI $3326-$4727]; p < 0.001), and practitioner ($3851 [95% CI $3410-$4292] versus $5306 [95% CI $4676-$5935]; p < 0.001) expenses during the follow-up. After risk adjustments, care bundle was associated with a 40% [95% CI 26-52%] reduction in mental health-related healthcare costs (p < 0.001) and 37% (95% CI 23-49%) reduction in all-cause healthcare costs (p < 0.001). CONCLUSIONS: Integrating a standardized mental healthcare bundle in pediatric EDs was associated with less healthcare use and cost savings. These findings support its broader use to enhance mental healthcare delivery in emergency settings.