Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England

Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England
Journal of Health Services Research & Policy 27 October 2020 https://doi.org/10.1177/1355819620963500

• This research examined the effectiveness of two integrated care models (Salford Together and South Somerset Symphony Programme) in terms of patient experience, generic health status (EQ-5D); and total costs of secondary care. 
• Both intervention sites showed an increase in total costs of secondary care (approximately £74 per registered patient per year in Salford, £45 in South Somerset) and cost per user of secondary care (£130–138 per person per year). There were no statistically significant effects on health status or patient experience of care. There was a more apparent short-term negative effect on measured outcomes in South Somerset, in terms of increased costs and avoidable emergency admissions, but these reduced over time.

The impact of frailty on the economic evaluation of geriatric surgery

The impact of frailty on the economic evaluation of geriatric surgery: hospital costs and opportunity costs based on meta-analysis.
J Med Econ. 2020;23(8):819-830. doi:10.1080/13696998.2020.1764965

• Two systematic reviews and meta-analysis to analyze the difference in costs between surgery for frail and non-frail elderly patients concluded that frail surgical geriatric patients generate a higher total hospital cost, and an opportunity cost arising from not operating in the best possible state of health. Preoperatively treating the frailty of elderly patients will improve the use of health resources.

Abstract

Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery.

Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery.
Clin Spine Surg. 2020;33(4):140-145. doi:10.1097/BSD.0000000000000982

• On the basis of the health-related quality of life outcomes, the cost-effectiveness of various spine surgeries can be determined, such as cervical fusions, lumbar fusions, microdiscectomies.

Abstract

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English NHS

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English National Health Service.
Value Health. 2020;23(6):719-726. doi:10.1016/j.jval.2019.11.011

• This study provides estimates of threshold prices for a range of potential improvements in the effectiveness of knee and hip replacement that could be realised from the adoption of computer- and robot-assisted knee and hip replacement.
• At a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY), the threshold price for a 5% improvement in post-primary unrevised quality of life (approximately equivalent to an additional two points in postoperative Oxford Knee Score [OKS]/Oxford Hip Score [OHS]) would be £10 000. The threshold price for a 50% reduction in the risk of revision would be £1000 per procedure.

Abstract

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness studyRapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study
British Journal of General Practice 2020; 70 (692): e186-e192. DOI: https://doi.org/10.3399/bjgp20X708077
Data from a pilot study at Neath Port Talbot Hospital indicates that a Rapid Diagnosis Centre for patients presenting with vague or non-specific symptoms suspicious of cancer in primary care reduces time to diagnosis and provides excellent value for money if run at ≥80% capacity.

Abstract

Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study.

Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study.
Health Serv Deliv Res 2019;7(37) October 2019

• Analysis of the cost of providing services to 298 young people with anorexia nervosa who are being treated in two different types of community services: specialist eating disorders services and general child and adolescent mental health services (CAMHS).  
• Young people in specialist services were found to be more severely ill than those in CAMHS when they were first diagnosed. Despite this, care for young people in specialist services cost about the same as care for those who were diagnosed in general CAMHS, and their outcomes after 1 year were also similar. 
• The authors conclude that specialist services may be better value for money than general CAMHS, but it did not show that providing more specialist services would save money for the NHS. 

Implementing changes to the eligibility criteria for cochlear implants in NHS Scotland

Implementing changes to the eligibility criteria for cochlear implants in NHS Scotland
Healthcare Improvement Scotland, SHTG team, 4 September 2019

• An estimate of the potential budget impact of changing the eligibility criteria for cochlear implants in Scotland. This follows a change to NICE guidance in England, which includes modifications to the clinical criteria for what constitutes severe or profoundly deaf, and how ‘adequate benefit’ from hearing aids is measured.
• Key findings
• Cochlear implants are deemed to be clinically and cost effective based on pre-existing NICE technology appraisal guidance (TA566).
• Changes to the assessment of eligibility for cochlear implants is expected to increase the number of people eligible to receive a cochlear implant in Scotland.

ACE MDC project approaches to understanding pathway cost

ACE MDC project approaches to understanding pathway cost
Cancer Research UK, July 2019

• As part of Wave 2 of the ACE Programme, five projects across England tested the viability of the Multidisciplinary Diagnostic Centre (MDC) model as an approach to improving outcomes for patients presenting with non-specific but concerning symptoms. This article addresses the challenges associated with achieving a full and rigorous evaluation of MDC cost effectiveness, before describing some of the practical approaches employed at a project level to understand pathway cost.

TAVI for the treatment of patients with severe symptomatic aortic stenosis who are at intermediate surgical risk

Transcatheter aortic valve implantation (TAVI) for the treatment of patients with severe symptomatic aortic stenosis who are at intermediate surgical risk
SHTG advice Statement and Evidence Note, 1 May 2019

• Based on commonly accepted UK cost-effectiveness thresholds, TAVI at list prices is unlikely to be cost-effective in patients with severe symptomatic aortic stenosis who are at intermediate surgical risk.

Advice for NHS Scotland

PET-CT imaging in patients with anal cancer

PET-CT imaging in patients with anal cancer
SHTG Advice Statement and Evidence Note, April 2019

Advice for NHS Scotland

NHS efficiency map updates

NHS efficiency map updated
HFMA, NHS Improvement and NHS England, updated 12 April 2019

• The map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) schemes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency. 
• Updated case studies on Theatres reporting and utilisation  and Aligned incentive contract.

Comprehensive Investment Appraisal Model and guidance for the NHS

Comprehensive Investment Appraisal (CIA) Model and guidance
DHSC 9 April 2019

• The CIA Model is for use by the NHS to support economic appraisals in business cases. It replaces the Generic Economic Model (GEM).
• The user guide shows how the CIA Model can be used to support economic appraisals in business cases. It provides guidance on the key economic principles, how these are used in economic appraisals and how the outcome of these appraisals is interpreted.

Cochlear implants for children and adults with severe to profound deafness - assessing benefits

Cochlear implants for children and adults with severe to profound deafness [TA566]
NICE Technology appraisal guidance 7 March 2019

• This guidance has been updated after a review of the criteria for defining severe to profound deafness and for assessing adequate benefit from acoustic hearing aids. No other sections of the guidance have been updated, so these are the same as in the original guidance. 
• Commissioners have 3 months from publication to implement these recommendations.
• "Currently around 1,260 people in England receive cochlear implants each year. These updated recommendations could lead to a 70% increase in that number, to 2,150 people, once a steady state is reached in 2024/25" - from NICE news item discussing the impact of the change, including costs.

Cost-Effectiveness of Bone SPECT/CT in Painful Total Knee Arthroplasty.

Cost-Effectiveness of Bone SPECT/CT in Painful Total Knee Arthroplasty
J Nucl Med. 2018 Nov;59(11):1742-1750

• The purpose of this study was to quantify the economic value of bone SPECT/CT versus CT or metal artifact reduction sequence (MARS)-MRI for the diagnostic assessment of recurrent moderate-to-severe pain after total knee arthroplasty (TKA). 

Abstract

Cost-Effectiveness of Surgical and Nonsurgical Treatments for Unicompartmental Knee Arthritis

Cost-Effectiveness of Surgical and Nonsurgical Treatments for Unicompartmental Knee Arthritis: A Markov Model.
J Bone Joint Surg Am. 2018 Oct 3;100(19):1653-1660. doi: 10.2106/JBJS.17.00837.

• In this preliminary assessment, recent expansion of surgical treatments into younger and older age demographics appears to be cost-effective in the setting of unicompartmental knee osteoarthritis. Our findings suggest that nonsurgical treatment should be used sparingly in patients below the age of 70 years and unicompartmental knee arthroplasty should be chosen over total knee arthroplasty in order to maximize cost-effectiveness.

PET/CT in investigating and/or assessing patients for diagnosis and/or staging of myeloma

PET/CT in investigating and/or assessing patients for diagnosis and/or staging of myeloma: evidence note 79
Scottish Health Technologies Group, Health Improvement Scotland, 4 May 2018

• Key points 

Cost-effectiveness of unicompartmental compared with total knee replacement

Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales
BMJ Open 2018;8:e020977. doi:10.1136/bmjopen-2017-020977

• This study examines the heath outcomes and lifetime costs (including revision) of unicompartmental knee replacement (UKR) compared to total knee replacement (TKR). 
• Analysis concludes that patients undergoing revision following UKR had better quality of life prior to and following revision than those who had TKR. For all subgroups, the hospital costs of primary and revision surgery were lower for UKR than TKR. The authors highlight a greater uncertainty for younger patients.
• While about half of patients who need knee replacement could be suitable for a partial replacement, but only 9% of the 98,147 knee replacements undertaken in 2016 were partial replacements.
• To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR.

Cost-Effectiveness in Adult Spinal Deformity Surgery

Cost-Effectiveness in Adult Spinal Deformity Surgery
Neurosurgery. 2018 Mar 16. doi: 10.1093/neuros/nyx575.

• This paper describes the different types of partial and complete economic analyses and offer a critical review of examples of each in various  Adult Spinal Deformity (ASD) study populations.
• The effect of ASD surgery on health related quality of life has been well documented, but the cost associated with changes in health status has not been well defined.

Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer.

Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer.

Head Neck. 2017 Dec;39(12):2470-2480

• An Australian study of eighty-two referrals concludes that a synchronous telepractice service provides cost efficiencies over standard care for providing remote specialist speech pathology head and neck cancer intervention.

Abstract