Early intervention project could be assessed as the business case. This is kind of patient’s care model, for which methods of cost calculation will be implemented, together with cost profitability assessment.
An example of proceedings which can be considered as an Early Intervention
Implementation of specific solutions introduced or planned in real world
An example of method for evaluation of proposed programme
Three models were distinguished from European research studies within MSK area.
Spanish Abasolo model
cost – benefit model
It is built on Spanish experience from 3 health districts in Madrid (Hospital Clinico San Carlos, Hospital Ramón y Cajal, and Hospital Severo Ochoa, Madrid, Spain). Abasolo study is comparison between the group of patients assigned to the early intervention protocol (intervention group) with the group of patients receiving standard care provided to MSK patient in Spain (control group).
Polish model of prevention and early diagnosis of Rheumatoid Arthritis
budget impact model
It is built on Polish programme which prepared to implementation to health care system based on pilot on national level. Main activities in programme is education of GPs, screening tools regarding preliminary diagnosis of rheumatoid arthritis and final validation of diagnosis by rheumatologist in ambulatory care.
The main comparison in model is cost of current care (based on cost based on hospital care and future care based on ambulatory care setting.
Model for economic evaluation of ‘PhysioDirect’ telephone assessment and advice services for patients with MSK in UK
cost effectiveness model
It is built on the experience from 4 community physiotherapy services in England (Bristol, Somerset, Stoke-on-Trent and Cheshire). The study included adult patients referred by their general practitioner or self-referred for physiotherapy, and compared PhysioDirect, i.e. telephone assessment and advice followed by face-to-face care if needed, with usual care i.e. patients placed on a waiting list for face-to-face care.
Types of Economic Analysis
The impact of implementing or adopting a particular technology or policy may be analyzed as follows:
- comparison of costs and benefits, both of them quantified in common monetary units,
- e.g. benefits expressed as savings resulting from decreased number of hospitalizations due to new treatment introduction
- comparison of costs in monetary units with outcomes in quantitative non-monetary units, e.g., increased time free from disease symptoms or quality of life, QALY, reduced mortality or morbidity
There are 3 key aspects to be considered when developing business case:
- Aim of EI programme – is it the same/similar as proposition presented in EI toolkit?
- Analysis type – how decision makers are to be convinced:
- Based on clinical arguments and costs?
- Based on impact on public payer budget / or public sector?
- Based on cost-effectiveness results?
- Data availability – what kind of data were already collected?
- See business case implementation options (next slide).
The following issues should be also taken into account:
- Credibility of data – the most reliable argumentation to decision makers would be that based on clinical data (published or collected locally) and costs collected locally.
- External validity – if created model is similar to original one, it is worth to consider differences and similarities between health care systems to which both models refer
- Communication – which model is the easiest to present and will most likely convince decision makers?
- Implementation – which model is the easiest to implement in real practise?
Three options of implementation
The range of data to be collected depends on the type of the model and may include:
- Number of patients entering the programme
- Characteristic of patients – age, sex, unemployment rate, etc.
- Distribution / flow of patients through different programme stages dependent on transition probabilities
- patient flow before programme introduction and changes resulting from programme activities
- Outcome measures – number of days of absenteeism, patient’s satisfaction, quality of life
- Resource use and costs – borne before programme introduction, changes after programme introduction, also directly related to the programme activities
The business case should include:
- Programme description
- Detailed information on organizational issues, intervention under assessment, expected effects and outcomes measured
- Calculation file
- The spreadsheet that allows to assess the effects of the programme implementation – in terms of health outcomes, resource use and costs and potentially cost-effectiveness ratios
- Results are calculated based on user input
- User manual that describes how to use calculation file
- Structure of the file
- Input data considered in the analysis
- Results assessed