Understanding Idiopathic Pulmonary Fibrosis patient care delivery and costs

Problem: Idiopathic Pulmonary Fibrosis (IPF) is a chronic condition, often with poor prognosis. Although there are NICE guidelines for managing IPF patients, care has varied across England; it has depended on how a clinic’s services are set up and what local resources are available. Our clients wanted to support local specialist centres as they document how their clinics managed IPF patients, how local pathways varied from the NICE benchmark care, and estimate affordability of providing care to patients.

Approach: We generated a gold-standard benchmark pathway for IPF patients based on the NICE guidelines and published literature using our pathway mapping tool, Dots. With our client we designed and conducted structured interviews with clinicians and service managers to explore how their IPF patients are managed and map out local pathways and resource use. Finally, we estimated the costs of care and compared it to our benchmark national pathway using the Dots.

Impact: All of the clinics were given their results so they could understand how their IPF pathways compared to the benchmark and to other clinics, both clinically and in cost-wise. It is anticipated that results could inform the development of a national tariff, as the estimated costs of providing care was over 40% more than currently reimbursed.

 

Related publications


presentation_iconHill C, Nasr R, Fisher MI, et. al. 
Estimated cost and payment by results (PBR) tariff reimbursement for idiopathic pulmonary fibrosis services across 14 specialist providers in England. British Thoracic Society Winter Meeting, London UK. 5th December 2014 MRC-2731

Increased efficiency and improved treatment for stable HIV patients in England

Problem: There was no guidance in England on how frequently stable HIV patients should attend clinics for routine visits, how frequently they should receive their HIV drugs and whether or not it would be cost efficient for patients to collect their drugs from the hospital pharmacy (which incurs VAT) or receive them through a home delivery (with associated delivery cost).

Approach: We built a simple spreadsheet tool in Microsoft Excel to estimate which strategy was the most cost-efficient. Local data from St George’s hospital were obtained and analysed, and supplemented with nationally published data as inputs in the model. Results suggested that the most cost efficient way of delivering care was to see stable patients for routine visits every six months in clinic, and give them their drugs through home delivery every three months; this would also save the most drug wastage for example if patients needed to switch to a new drug regimen. Results suggested that this could save roughly £2000 per patient annually, and roughly £8 million if it were implemented across England to the 4000 HIV patients in 2012.

Impact: Results were given to the London HIV commissioners, published in a peer-reviewed journal, and the tool is available to healthcare professionals so that they can put in their local data to help them make better decisions about healthcare provision.

 

Testimonial

“It has been a pleasure to work with Dr Elisabeth Adams on our costing project for HIV home delivery of drugs. I have also worked with her on research related to the POPI study of chlamydia screening.

She has a very professional and thorough approach to her work, and is good at delivering to timelines. I can recommend her as a partner for future work.”

  • Dr Phillip Hay, Reader and Honorary Consultant, Sexual Health and HIV Medicine, St. George’s Hospital, London

 

Related publications

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

Please contact us to request a version of the tool.

The true cost of treating invasive fungal infections in hospitals

Problem: Our client’s drug is recommended in most guidelines as a first line treatment for invasive fungal infections in immunocompromised patients. But because its acquisition cost can be comparatively high, health care purchasers have tended to favour its lower-cost competitors. To challenge this perception, our client wanted to know what the total healthcare costs were of treating patients with invasive fungal infection with its drug compared to alternatives, and to help customers understand the wider costs of patient management.

Approach: We took a two-pronged approach. First, we assembled a multidisciplinary team, to work closely with our client’s market access and medical teams in the UK, Ireland, and internationally. We reviewed the published evidence base of the side-effects, effectiveness and costs of its drug and its alternatives, and built a simple, user-friendly Excel tool that could be used with their customers to demonstrate the total treatment costs of theirs and competitors’ drugs. National data for the baseline values in the tool were used, but we incorporated a simple interface so that customers could use local patient data and costs for a personalised result.

Next, we worked with clinicians at Kings College Hospital NHS Foundation Trust to analyse data collected prospectively as part of a study of haematology patients receiving antifungal treatment in hospital. This patient level analysis explored the costs of antifungal and antibiotic drugs, diagnostic tests, and hospital stay. We found that the driver of costs was the underlying inpatient stay, which was much higher than the cost of antifungal drugs.

Impact: Our client’s sales team have reported that our tool has been integral in their work and as part of their evidence base. They can help their customers understand the total costs of different treatment strategies, and it has prompted several clinics to audit their own local data and then use it in the tool to estimate the impact of drug use on their overall costs. Results from the analysis at Kings College Hospital provided much needed evidence of the costs of care for IFD patients, which can be used to inform local and national tariffs. More generally, the project has helped raise awareness of the wider issues of cost, rather than focusing on the drug acquisition cost alone.

 

Testimonial

“Through working with Elisabeth and her team I have been able to develop excellent tools which have been relevant to our customers and valuable to our sales team. Aquarius is flexible to my needs and able to adapt their approach as situations and demands change. I have always found Elisabeth to be very knowledgeable and professional and I thoroughly enjoy the partnership we have developed. I would definitely recommend working with Aquarius!”

  • Manager, Market Access & Reimbursement, pharmaceutical company

“The Aquarius team conducted an analysis of individual patient data from our hospital. They were very proactive and responsive throughout our collaboration, and although we had quite complicated data, they delivered excellent results ending in a peer-reviewed publication.”

  • Dr Tony Pagliuca, Clinical and Transplant Director, Chair of DH BMT CRG, and Professor of Stem Cell Transplantation, King’s College Hospital NHS Foundation Trust
  • Dr M. Mansour Ceesay, Consultant Haematologist, King’s College Hospital NHS Foundation

 

Related publications

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A. Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

presentation_iconAdams EJ, Kendall E, Horner J, Marsh R. Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease. ECCMID 2015. 25 – 28 April 2015. Copenhagen, Denmark.

The benefits and cost-savings of a new point-of-care test for chlamydia and gonorrhoea

Problem: Cepheid’s Xpert® CT/NG test is a high performance point-of-care test for chlamydia and gonorrhoea, and offers a promising advance in the diagnosis and control of two common sexually transmitted infections. When the test was launched in 2013, Cepheid wanted to understand how sexual health clinics in England might use it and to develop evidence comparing its costs and benefits to standard laboratory tests.

Approach: We approached the challenge in two projects. For the first, we defined the current patient pathways for chlamydia and gonorrhoea testing treatment and compared them to what they would be if a rapid POCT was used. We held workshops with staff in four sexual health clinics, asking them to map out the current patient pathways for chlamydia and gonorrhoea diagnosis and treatment. We then helped them brainstorm ways in which their services might include a point-of-care chlamydia and gonorrhoea test, and describe how this would change their patient pathways. Finally, we used Dots, our cloud-based pathway builder tool, build to estimate the costs of the pathways. The work indicated that the pathways could be streamlined with a point-of-care test, and we estimated that this would cost less to deliver than current practice.

For the second project, we developed an economic model to compare the overall costs and benefits of a point-of-care test to standard care. We combined the results of our first project with previous work our team had conducted on chlamydia and gonorrhoea testing and management. The model showed that the test could deliver £10million in cost savings, and give far more effective management of chlamydia and gonorrhoea at a population level. Our results were published in Sexually Transmitted Infections, and have been presented at national and international conferences.

Impact: Our work gave Cepheid the empirical evidence to demonstrate the value and potential impact of adopting their test in clinics. Since our projects, Cepheid has had increasing interest in the test, and several centres have purchased it. This includes a major London sexual health clinic which has introduced a new testing service as a result.

 

Testimonial

“I started working with Aquarius in 2012. Elisabeth and her team have always delivered great results, including 2 peer-reviewed publications, that add real value and insight, and they come up with creative ways to answer our questions. I enjoy collaborating with them and look forward to continuing our work on a range of disease areas in the future.”

  • Dr. Anne Postulka, Senior Director Medical & Economic Value, Cepheid

 

Related publications

publication_iconAdams EJ, Ehrlich A, Turner KME, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014;4: e005322. doi:10.1136/bmjopen-2014-005322

publication_iconTurner KME, Round J, Horner PJ, et. al. What are the clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England? Sex Transm Infect. Published online 22 Nov 2013: doi:10.1136/sextrans-2013-051147

Featured article: Read the Clinical Services Journal about this work.

 

Managing Mycoplasma genitalium as an STI

Mycoplasma genitalium is a prevalent sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. Diagnostic tests are needed to reduce the risk of the development of antimicrobial resistance and improve patient care.

publication_iconHorner P, Blee K, Adams E. Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1g! Curr Opin Infect Dis. 2014; 27:1:68-74.

 

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The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study

Switching to cheaper generic antiretroviral drugs for HIV patients may appear cost saving over fixed-dose combinations, and be an appealing way to reduce healthcare costs. However, the additional clinical costs may outweigh the initial cost savings of the drugs, and switching may cause confusion for some patients, risking loss of adherence. Our analysis provides evidence that can help commissioners make better policy decisions about drug provision.

publication_iconTaylor R, Carlin E, Sadique Z, Ahmed I, Adams EJ. The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study. Int J STD AIDS 0956462414530588, first published on April 3, 2014 as doi:10.1177/0956462414530588

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Point-of-care testing leads the way: article in the Parliamentary Review 2014

Rapid point of care test for sexually transmitted infection diagnosis will allow greater access to high quality care, ensure patients get the correct treatment for their infections, and return to health sooner, reducing the need for follow-up care and preventing onward transmission and complications.

publication_iconPrice C, Adams E, Horner P. Point-of-care testing leads the way. Parliamentary review: Sept 2014

 

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The cost of managing haematology patients with invasive fungal disease

We aimed to estimate the cost of care for patients with invasive fungal disease (IFD) in England. We analysed prospectively collected data from adult haematology patients in a large hospital in London. We found that the attributable cost of managing IFD was greater than £50,000 per case, with the inpatient stay accounting for 3/4 of costs. Costs for inpatient stay far outstrip the cost of antifungal drugs.

publication_iconCeesay MM, Sadique Z, Harris, R, Ehrlich A, Adams EJ, Pagliuca A.
Prospective Evaluation Of The Cost Of Diagnosis And Treatment Of Invasive Fungal Disease In A Cohort Of Adult Haematology Patients In The United Kingdom. J Antimicrobial Chemotherapy. 2014; doi: 10.1093/jac/dku506.

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The cost and tariff reimbursement of idiopathic pulmonary fibrosis in England

We explored patient pathways for the diagnosis, management and monitoring of idiopathic pulmonary fibrosis (IPF). This was based on NICE published pathways, and interviews with healthcare staff from 14 hospital trusts across England. Data were used in our in-house tool to estimate the cost of each pathway, which were compared to the tariff reimbursement. We found large variation across England in how services for IPF patients are delivered, and variation compared to the NICE pathway.

View PosterHill C, Nasr R, Fisher MI, et. al. Estimated cost and payment by results (PBR) tariff reimbursement for idiopathic pulmonary fibrosis services across 14 specialist providers in England. British Thoracic Society Winter Meeting, London UK. 5th December 2014 MRC-2731

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Treatment for stable HIV patients in England: can we save costs and improve patient care?

We estimated the costs of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients in England. Results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the least expensive option and could result in £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in England.

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

 

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