Session 4.1 – Adapting Burden of Disease for Priority Setting
Thursday October 30 11:30-12:30
The Problems of Measuring Benefits at the Level of Population
(Abstract 0046)Nikos Argyris
London School of Economics & Political Science, United Kingdom
Policy requirements call for the ‘strategic commissioning’ of healthcare services, which, as widely accepted, should be based on a robust, evidence-based priority setting process. This requires estimates of the impacts of policies on the health of populations. As part of the Health Foundation’s £2.5 million, five-year QQUIP research initiative which stands for the Quest for Quality and Improved Performance we have developed a framework, using routinely available data, to produce sound estimates of the ‘avoidable’ Burden of Disease from different health care interventions, in a way that is transparent to decision makers. At the core of this framework is the use of population-based disease models for the estimation of (net) health benefits. The purpose of this talk is to discuss in more detail the problems encountered in applying a theoretical framework in practice and possible solutions. We explore issues such as: the methodological implications arising from the use of QALYs or DALYs.
The Burden / Effectiveness Fallacy: The Case of Treatment and Prevention of Strokes
(Abstract 0047)Mara Airoldi
London School of Economics & Political Science, United Kingdom.
Although conventional studies of cost-effectiveness analysis (CEA) focus on the Incremental Cost-Effectiveness Ratio (ICER), they often begin with reference to the BoD and it is thus implied that an intervention that is shown to be cost-effective will have a material effect by reducing the BoD. We show that this is not so for stroke. Cerebrovascular diseases account for a massive burden of disease in developed countries; in the UK, they are the third most common cause of death and the leading cause of adult disability. Of these diseases, stroke is the most important; it accounts for 80% of cerebrovascular deaths every year. Studies have shown that it is highly cost-effective to treat stroke patients in a specialised stroke unit: the benefits have been shown to be statistically significant with no increase in costs. It is also cost-effective to give thrombolytic treatment to stroke patients within three hours of stroke onset. Current national priorities in England for treatment of stroke are to increase the percentage of stroke patients treated on stroke units from 50 to 100 per cent, and the numbers given thrombolytic treatment within three hours of stroke onset. If these policies were fully implemented, however, that they would not have a material effect in reducing the BoD from stroke. Taking into account the scale of the benefits highlights the importance of strategies to prevent strokes by e.g., reducing hypertension or the salt content of food.
The PCT Perspective: How the Concept of the ‘Avoidable’ BoD Relates to Setting Priorities in a PCT
(Abstract 0050)Mara Airoldi
London School of Economics & Political Science, United Kingdom
A central challenge facing the British NHS is turning ‘World Class Commissioning’ from an aspiration into practice by Primary Care Trusts (PCTs). This requires a strategy to set priorities to meet needs of their populations to achieve defined improvements in health. Through NICE, England has built a formidable body of systematic evidence on the clinical and economic dimensions of a number of specific interventions to help set priorities. These evaluations follow the convention of cost-effectiveness analysis in focusing on the Incremental Cost-Effectiveness Ratio. We argue such information is inadequate for strategic commissioning by PCTs as they need to consider, not just specific interventions in isolation, but the totality of a care pathway, including long-term benefits from prevention. PCTs also must take account of the scale effects of any change. We developed the concept of 'avoidable' Burden of Disease (BoD) and assessed its ability to support World Class Commissioning by working with a PCT. The concept was used in two ways. First, at the beginning of the planning cycle to formulate a Joint Strategic Needs Assessment and to move from prevalence and mortality statistics to focusing on the potential for reducing need through healthcare interventions in the short and in the long term. Second, we used this information in a series of working meetings with key stakeholders to support priority setting and to inform the commissioning strategy. This paper captures the learning from this exercise, and discusses the usability and information requirements of the 'avoidable' BoD framework.