What is the cost of the service

1

• What is the cost of the service?
• An economic evaluation of a therapy and support
  service for people with
• long-term stroke and aphasia
• Anna van der Gaag,
• University of Glasgow
• Richard Brooks
• University of Strathclyde

2
The context

• Connect the Communication Disability Network
  London UK

3
What is Connect?

• Long term therapy and support to people with
  aphasia and their families
• Focus on living with aphasia therapies
• Therapy, counselling, family support
• Multi-disciplinary approach
• Wide range of Therapy Programmes
• Therapy in Groups
• Extensive Education Programme as well as Therapy
  Programme

4
The study

• A independent
• evaluation of therapy
• and support services at Connect

5
A Mixed Methodology

Interviews with relatives (n22)
Interviews with people with aphasia (n38)
Researcher observations of therapy
Gathering different types of evidence
Assessments before and after therapy
Economic evaluation
6
Assessments used in the study
7
Aims of the economic evaluation

• To undertake an economic evaluation in a
  voluntary sector setting providing therapy for
  people with aphasia and their families
• To compare costs with hypothetical NHS costs

8
Methods used in economic evaluations

• cost description analysis
• cost benefit analysis
• cost minimisation
• cost utility analysis
• (Drummond et al, 1997)

9
Why cost utility?

• a well-established methodology
• provides a cost measurement of the quality of
  life gained following treatment or therapy.
• combines outcome data with the cost of delivering
  specific programmes to generate QALYs (Quality
  Adjusted Life Years).
• more powerful tool than a cost description
  analysis in which the overall costs of a
  programme are calculated without any reference to
  the outcomes of care.

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Stage 1

• Calculate the actual cost of delivering therapy
  and support services at Connect.
• Costs broken down into categories used to
  calculate equivalent costs in the NHS
• staff costs
• cost of materials and equipment
• cost of overheads, including cost of travel, and
  values of travel time ie unit of resource for
  travel time to and from centre

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Stage 2

• Comparing these costs with equivalent services in
  the NHS
• ie calculating the cost of delivering an
  equivalent aphasia group therapy programme in an
  NHS setting.

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Stage 3

• Calculating QALYS (Quality Adjusted Life Years)
• A method for calculating the gains made in terms
  of quality of life
• (QALYS number of years a person may live beyond
  the illness and the utility gained in terms of
  quality of life in those years)

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QALYs

• How are QALYs generated?
• Usually from Quality of Life measures
• EQ-5D generates a figure corresponding to
• an individuals heath state
• Each score has a Tarriff value
• Compare values before and after a programme of
  therapy/intervention
• QALY gain or loss is the difference between two
  values

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Calculating QALYs

• Total cost of the programme
• _________________________
• Total QALY gain

15
Examples of QALY data

• 12 month programme for treatment
• of depression in primary care 9,000
• 6 wks CBT for insomnia 2,850
• 9 mth weekly OT for 60 pts
• in residential settings 8,000
• U.S. data from Hay et al, 2002

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Costs Connect Starter Programme
Costs for 7 week programme for 17 clients
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Costs Connect Starter programme (cont)
Values for non working time spent in
travel from Department of Transport (2002) 3.74
per 60 mins Mean time 75 minutes 4.67X17X 7
566
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Costs Connect Conversation Group
(Costs for 12 week programme for 15 clients)
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Costs Connect Conversation Group (cont)
Values for non working time spent in
travel From Department of Transport
(2002) 4.67X12X15 841
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Costs NHS SLT Programme
Costs for 7 week programme for 17 clients
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QALY

• Overall QALY gain of 3.391 for those assessed on
  EQ-5D
• QALY 1,474
• How?
• Cost of Starters Therapy Programme 4998
• (4998.49 divided by total QALY gain of 3.391)

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QALY data

• No equivalent published figures for aphasia
  therapies
• Stroke interventions QALY ()
•  
• Carotid enarterectomy 4,500 30,000
• Anticoagulants (non valvular atrial fibrillation
• (medium risk Pts) 4,500
• Anticoagulants (non valvular atrial fibrillation
• (low risk Pts) 211,200
• Neurosurgical clipping for cerebral aneurysms
  17,500
• Surgery and radiosurgery for AVM
• (Arteriovenous malformations)
  4,880
• U.S. data from Holloway et al, 1999
• 1.75 1.00

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Stage 4

• Calculating unit costs
• Compare with unit costs in equivalent NHS,
  voluntary and social care sectors
• Data from Netten and Curtiss Units costs of
  Health and Social Care. University of Kent

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Unit Costs
Cost of programme divided by no of weeks divided
by number of clients
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What does an economic costing add to the
evaluation of therapy?

• Determines costs of a programme
• Provides comparative data within and between
  services
• This study also explored feasibility of using
  QALYs in an SLT context

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Implications

• Is economic evaluation useful?
• Does costing improve our ability to deliver
  services?
• Can it create stark choices in terms of service
  delivery?
• Does it add value?

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Conclusions

• Economic evaluation is one component of
  intervention studies
• Can add to our understanding of what we do
• Methodology can be applied in other contexts
• (SLT service reports, business case for SLT,
  etc)

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Conclusions

• Practical life cannot proceed without
  evaluation, nor can intellectual life, nor can
  moral lifethe real question is how to do
  evaluation well
• Scriven, 1991

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References

• Brooks, R. with the EuroQol Group (1996).
  EuroQol the current state of play. Health
  Policy, 37, 53-72
• Department of Transport (2002) Transport
  Economics Note (TEN) Values of Time
• Drummond, M, OBrien, B, Torrance, G., OBrien,
  B, Stoddart, G. (2005) (3rd Ed) Methods for the
  economic evaluation of health care programmes.
  Oxford Oxford Medical.
• Hay, J,Labree, L Luo, R Clark, F (2002) cost
  effectiveness of preventive OT for independent
  living older adults. J Am Geriatric Soc 50 (8),
  1388-88.
• Netten, A, Curtiss, L (2002) Unit costs of health
  and social care. PSSRU University of Kent
• Robert G. Holloway, MD, MPH Curtis G. Benesch,
  MD Catherine R. Rahilly, BA Caryn E. Courtright,
  BS (1999) A Systematic Review of
  Cost-Effectiveness Research of Stroke Evaluation
  and Treatment. Stroke301340-1349.)
• Silvia M., Evers, A., Ament, J, Blaauw, G. (2000)
  Economic Evaluation in Stroke Research A
  Systematic Review. Stroke 31 1046-53
• Tengs, T., Yu, M., Luistro, E (2001) Health
  related quality of life after stroke a
  comprehensive review. Stroke 32 964.
• van der Gaag, A, Smith, L, Davies, S, Moss, B,
  Mowles, C. (2005) Connect therapy and support
  services for people with long term stroke and
  aphasia and their relatives a six month follow
  up study. Clinical Rehabilitation, 19, 372-81.
• Williams, A. (1995) The Role of the EuroQol
  Instrument in QALY Calculations. Discussion Paper
  130, Centre for Health Economics, University of
  York.