Table 4.

Economic outcomes

Study (Yr)	Country	Social Economic Background	Perspective	Cost variable included in analysis	Type of economic evaluation	Outcome
Crane (2012)	USA	Low income, uninsured.	Healthcare	Hospital charges ($1167 per month pre-intervention, $230 post-intervention); cost of program ($66 K)	Cost analysis	ED use dropped by 0.25 per patient per month 0.23 and hospital charges dropped from $1167 per patient per month to $230.
DeHaven (2012)	USA	Uninsured	Healthcare	Indirect costs (sum of costs for all ED visits for the year, includes fixed costs related to building maintenance, staffing and utilities)	Cost analysis	Intervention enrolees of the PAD program had significantly fewer ED visits (0.93 vs 1.44). Direct hospital costs around 60% less ($1188 vs 446). Indirect costs 50% less ($313 vs $692).
Edgren (2016)	Sweden	“Screening aimed to identify patients who seemed to be lacking in health literacy, sought care at an improper level, or from too many providers”.	Healthcare	Costs of conducting maintenance activities ($13,950.42), total program cost ($54,284.31). Per-client discretionary costs for transport, equipment, medications and interpreters ($250 per person).	Cost analysis	The traditional design showed an overall 12% decreased rate of hospitalization, which was mostly driven by effects in the last year.
Enard (2013)	USA	Publically insured (Medicaid), uninsured (self pay), or covered by a local public health benefit that subsidises medical costs for eligible residents.	Healthcare	Prior to enrolment: ED charges ($8,453,761), inpatient charges ($8,453,761). Post-intervention: ED charges ($3,041,473) and inpatient charges ($5,405,175).	Cost analysis	The savings associated with reduced PCR-ED visits were greater than the cost to implement the navigation program.
Grimmer-Somers (2010)	Australia	Unplanned ED use, crisis inpatient admission, poor attendance at primary health and/ or outpatient clinics, unmanaged chronic disease, medication misuse, vulnerable social circumstances.	Healthcare	Gross charges and expenses, ED service charges and expenses, IP service charges and expenses, outpatient service charges and expenses.	Cost analysis	Staff spent 34 h with each client, costing $1700 each. Crisis ED and inpatient admissions decreased. Planned outpatient clinic use increased.
Grover (2018)	USA	Patients who demonstrated a propensity for future problematic ED encounters such as violence in the ED or prescription forgery.	Healthcare	Average direct costs per patient for intervention and control groups.	Cost analysis	ED and hospital charges decreased by 5.8 million dollars (41% reduction)
Hardin (2017)	USA	Patients who would benefit from a Complex Care Map	Healthcare	Direct treatment costs (wages, salaries, materials); indirect costs (those incurred as part of the production process (e.g. admin costs, maintenance costs)	Cost analysis	ED mean visits decreased 43%, inpatient admission decreased 44%. Gross charges decreased 45%, direct expenses decreased 47%.
Lin (2017)	USA	NR	Healthcare	Hospital service costs	Cost analysis	Average ED direct costs 15% lower for intervention patients. Average inpatient costs per patient 8% lower.
Murphy (2013)	USA	NR	Healthcare and fire department	Health care system costs - total costs for transport or non-transport responses based on predicted or actual call volume.	Cost analysis	Frequent and extreme users decreased in ED visits (5 and 15 respectively) and direct treatment costs ($1285) leading to significant hospital cost savings.
Navratil-Strawn (2014)	USA	Insurance scheme	Healthcare	Hospital inpatient and outpatient Medicare costs (not charges). ED physician costs not included in this study.	Cost analysis and ROI	Participants had greater reduction in ED visits (p = 0.003) and hospital admissions (p = 0.002) and increased office visits (p = < 0.001). ROI of 1.24.
Okin (2000)	USA	Program aimed to decrease homelessness, decrease alscohol and substance use and improve linkages to primary care providers, reduce health care utilisation and enrol patients without meical insurance to medicaid.	Healthcare	Medical inpatient costs, psychiatric emergency costs, psychiatric inpatient costs, medical outpatient costs, physicians’ professional fee costs, non EDCM costs	Cost analysis and ROI	Median number of ED visits decreased from 15 to 9 (p < 0.1) and median inpatient costs decreased from $4330 to $2786 (p < 0.1). ROI of $1.44.
Reinius (2012)	Sweden	NR	Healthcare	Ambulance and hospital charges as proxy for cost of care. No evaluation of individual insurance status or reimbursements.	Cost analysis	Intervention reduced the total healthcare costs for per person hospital admissions by 45%.
Seaberg (2017)	USA	NR	Healthcare	Total healthcare cost, primary and secondary care visit costs for outpatient care	Cost analysis	ED visits decreased overall with a larger decrease in the intervention group (by 13.2%) compared to the control group (by 4.5%).
Shumway (2008)	USA	Subjects had psychosocial problems that could be addressed with case management (problems with housing, medical care, substance abuse, mental health disorders or financial entitlements).	Healthcare	Total costs of the intervention and total cost per person	Cost analysis	Reductions in ED use and cost did not translate to reductions in inpatient use, which represent a larger proportion of total hospital service use.
Stokes-Buzzelli (2010)	USA	89% of the study population had substance abuse issues.	Healthcare	ED charges	Cost analysis	ED charged decreased by 24% (from $64,721 to $49,208). The number of lab studies ordered decreased by 28%. The number of average ED visits decreased by 25%.
Tadros (2012)	USA	NR	Healthcare	Total healthcare costs for hospital admissions	Cost analysis	Pre-hospital based case management system is effective in decreasing transport by frequent presenters but had only a limited impact on use of hospital services.

NR Not reported