Measuring Cost and Impact

1. Measuring Cost and Impact Nick Hex Project Director 28 March 2012

2. Understanding the economics – why is it important? • Importance of cost effectiveness in decision-making; • Changing commissioning landscape; • Funding restrictions – QIPP; • NHS Outcomes Framework.

3. Increasing survivorship

4. Economic costing • February – October 2011: • Models of the costs of different approaches to survivorship; • Based on activity and costs at 4 pilot sites; • Proxy costs and assumptions used.

5. Economic costing • Key findings: • The costs of LTFU care costs in secondary care have been reduced by risk stratification of patients • New models of care increase capacity to provide care for more survivors; • But good practice models of care may require additional costs.

6. Economic modelling

7. Objectives • Our remit: • Identify additional variables that will influence the cost of the new pathways and describe the effects of these; • Produce a more detailed model of costs for a LTFU service; • Develop the costing methodology into a model which can be easily used by commissioners and care providers to understand the costs of survivorship.

8. Additional cost factors • Implementation and start-up costs; • Quality improvements, eg, care coordinators, transition clinics etc; • Services outside the acute sector.

9. Literature review • Very little data or published studies; • Costs, but no activity, for primary care; • Services outside the acute sector do not have negative impacts on patient care.

10. Economic modelling: inputs

11. Economic modelling: inputs • Investigation costs; • Quality additions; • Additional primary care visits: • GP time; • Investigations. • Tariff income.

12. Costing scenarios • Costs of treating 900 survivors with and without risk stratification; • The effect on the commissioning body and the hospital provider of changing service provision, ie. the impact of changing tariff income

13. Scenario 1: hospital costs

14. Scenario 2: tariff impact

15. In summary • Costing model indicates that hospitals may reduce costs through risk stratification but tariff income may also be reduced; • Commissioners likely to incur additional primary care costs; • More research needed around outcomes and the provision of services outside of secondary care;

16. Next steps • Finalise model and issue for consultation, along with a user guide; • Develop further scenarios; • Draft report for NHS Improvement/NCSI.

17. Thank you Nick Hex nick.hex@york.ac.uk 01904 324830