QOF cost effectiveness methodology

1
QOF cost effectiveness methodology

• Jennifer Field, Associate Director Costing

2
Structure

• Background
• Principles
• Methodology
• Indicators with no cost effectiveness information
• Discussion questions

3
BackgroundQOF proposals about cost effectiveness

• ..all indicators proposed for inclusion in the
  QOF are based on evidence of clinical and cost
  effectiveness
• ..there is an objective and transparent system
  for setting the value of a QOF indicator
• ..information on existing indicators would also
  be provided a review of whether it remains
  cost-effective to continue to incentivise these
  indicators.
• Developing the quality and outcomes framework
  Proposals for a new, independent process, DH

4
BackgroundWhy consider cost effectiveness?

• Economic evaluation in health care addresses the
  question of whether an intervention or procedure
  is worth doing when compared with other possible
  uses of the same resources. M.F. Drummond

5
Principles

• Indicators can be considered cost effective when
  net benefit is greater than zero.
• Net benefit (monetised benefit-delivery
  cost)-QOF payment
• The monetised benefit is derived from expected
  increase in quality adjusted life years (QALYs)
• Delivery costs includes all costs to the NHS and
  social care system estimated to arise from
  increase in uptake
• The QOF payment is considered to be additional to
  delivery cost as an incentive to increase
  evidence based care

6
QALY threshold range
1
Probability of rejection
0
20
30
Cost per QALY (000)
7
Methodology worked example
8
Methodology - example output
9
Methodology issues

• Accuracy of data for areas new to QOF
• Delivery costs affecting different sectors
• Availability of estimates of incremental effect
• Monetised benefit is not realisable cash
• Net benefit is not a target
• Cost effectiveness is only one element considered

10
Indicators with no cost effectiveness data

• Proposed QOF payment delivery cost
• Minimum monetised net benefit
• This can be expressed as or min. QALY gain
• In isolation this data is of limited use but
  presented along side data on other indicators
  with known net benefit a judgement of how likely
  the benefit will be achieved can be made.

11
Discussion questions

• Consider and comment on the general
  methodological approach
• Is there potentially a tension between
  prioritising the most cost effective indicators
  and reducing health inequalities? How could this
  be dealt with through the methodology or the
  prioritisation process?