There is a temptation to switch to cheaper generic antiretroviral drugs compared to fixed-dose combination therapy for HIV patients in the interests of cost savings. However, in our analysis we found that there were no costs saved when including all patient care including drugs, additional clinic visits and monitoring. We also found that switching may cause confusion for some patients, risking loss of adherence. This evidence can help commissioners make better policy decisions about drug provision.
We explored patient pathways for the diagnosis, management and monitoring of idiopathic pulmonary fibrosis (IPF) across England, based on NICE pathways, and interviews with healthcare staff from 14 hospital trusts. Data were used in our in-house tool to estimate the cost of pathways, compared to tariff reimbursement. We found large variation across England in how services for IPF patients are delivered, variation compared to the NICE pathway, and costs >40% more than what is currently reimbursed.
Collaborators at St Georges Hospital wanted to understand the impact of changing service provision for stable HIV patients, as no evidence existed on what was best for clinics. We built a tool in Excel, and results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the cheapest option and could yield £2000 savings per patient, translating to an annual cost reduction of ~£8 million for the estimated 4000 eligible patients not currently on home delivery in England in 2012.
We first created a generic framework to help decision-makers think about how to compare patient management whilst considering all costs to the healthcare provider. Then, we developed a specific tool for management of patients with invasive fungal disease (IFD). Lastly, we estimated that the attributable cost of managing adult haematology patients with IFD at Kings College Hospital (London) was more than £50,000 per case, with the inpatient stay cost far outstripping the cost of antifungal drugs.