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Increasing survival is associated with increasing numbers of adults with cystic fibrosis (CF). It is recognised that management at specialist CF units is associated with improved health outcomes.1 Assessment of the allocation of staff and resources to adults with CF and accurate costing of these services are essential to enable evaluation of the cost effectiveness of the existing CF services and prediction of future requirements. Global costs of care for young people with CF have been estimated, but studies of the cost of providing physiotherapy for a CF service are scarce.2 3
The cost and utilisation of providing a physiotherapy service to inpatients with CF was determined from February to June 1999 (late summer, autumn and early winter). Using staff designation (pay level), time of physiotherapy (in 5 minute unit allotments), and after hour penalties incurred, comparison was made with actual funding for the service. At the time of the study the Adult CF Unit at the Prince Charles Hospital in Brisbane provided clinical care for 120 adults with CF from throughout Queensland, with patients travelling up to 1800 km. Despite an active home intravenous antibiotic programme, many patients require admission for treatment of pulmonary exacerbations. Physiotherapy management included respiratory therapy, education, and exercise and was available to all inpatients with CF on a 24 hour basis when required. Outpatient and domiciliary physiotherapy service provision were excluded from this analysis.
During the 5 month study period (150 days) there were 102 inpatient admissions in 58 patients (mean length of stay 12.1 days). Two patients (with two admissions each) were inpatients for a total of 116 and 129 days, respectively, and two patients died during the study. In 5 months 1498 hours of physiotherapy were provided at a cost of £13 700 ($AUD38 000), equating to £12 ($AUD32) per patient per day. This involved a mean of 9.9 hours of physiotherapy per day. This cost exceeded funding for the service by 28% (£630/month). The total time of physiotherapy varied from 233 to 401 hours per month. The majority of the service was provided during normal working hours (72.9%). Due to penalty wage rates for after hour's work, only 58.5% of the total cost was provided during normal working hours. The weekend and public holiday physiotherapy used 22.8% and 3.3% of the time but accounted for 33.6% and 6.8% of cost, respectively. Physiotherapy care provided during weekday evenings amounted to 1% of total time and total cost.
This analysis shows that the cost of inpatient physiotherapy in a tertiary referral service is £92 ($AUD253) per day or £12 per patient per day. Provision of a service outside normal working hours accounts for a significant proportion of the cost of this service. Regular analysis of time utilisation is required to determine if adequate staffing levels and funding are available to meet the challenge of an increasing population of adults with CF.