use of models to evaluate health policy lessons from the national audit office
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Use of Models to Evaluate Health Policy Lessons from the National Audit Office. Quantitative Modelling in the Management of Health Care Tom McBride 30 th March 2010. What does the National Audit Office do?. Scrutinise the economy, efficiency and effectiveness of public spending. - PowerPoint PPT PresentationTRANSCRIPT
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Quantitative Modelling in the Management of Health CareTom McBride
30th March 2010
Use of Models to Evaluate Health Policy
Lessons from the National Audit Office
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What does the National Audit Office do?
Scrutinise the economy, efficiency and effectiveness of public spending.
Totally independent of Government. Audit the accounts of all Central
Government bodies; AND produce around 60 value-for-money
reports each year (6 on health issues) Work with Parliament’s Public Accounts
Committee (PAC), whose hearings are based on our work.
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The NAO Value for Money Cycle
Strategy
Fieldwork/Examination
Government Response
Follow up
Committeeof Public Accounts
DraftingPublication
Clearance
The vfm cycle
Planning?
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Aim of the Presentation
Brief outline of some recent health models
Discuss advantages of using models in policy evaluation
Present the challenges of using models to evaluate and inform policy development
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End of Life CareNovember 2008
Used a Markov model to examine the financial consequences and patient benefits of allowing more people with terminal conditions to be cared for and die at home.
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Community
Hospital Hospice
Community
Hospital Hospice
Community
Hospital Hospice
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End of Life CareConclusions
Found that for cancer alone around £100 million could be released by delivering relatively small reductions in emergency admissions and length of hospital stays
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Healthcare Associated InfectionsJune 2009
Used a systems dynamic model to examine the impact of various interventions designed to limit the spread of c.difficile by modelling the spread of an infection through a hospital
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Healthcare Associated InfectionsConclusions
Found that more frequent hand washing, bed and toilet cleaning had little effect on their own. All had to be increased to contain the spread of an infection
Showed that identifying and isolating patients has the greatest effect on limiting the outbreak
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Supporting People with AutismJune 2009
Used a decision tree to explore the costs and benefits of providing specialist health, social care and employment services for adults with high-functioning autism
Compares current service provision with a counterfactual where specialist support is available throughout England.
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Supporting People with AutismConclusions
Identification of 4% of target group would be cost neutral; 8% identification could save the taxpayer around £67 million per year
Savings would come from decreased benefit payments, increased tax revenue and decreased use of supportive accommodation
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Rheumatoid ArthritisJuly 2009
First model compares current cost of services with more rapid identification and treatment in primary care
Second model looks at the impact that more rapid identification and treatment across all care would have on NHS costs, productivity and quality of life
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Rheumatoid ArthritisConclusions
Increasing people treated within 3 months by 10% would cost NHS £11m over 5 years. This would become cost neutral after 9 years
However, this could also lead to £31m in productivity gains for the economy and a gain of 4% in QALYs
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Progress in Improving Stroke CareFebruary 2010
Used to discreet event simulation to model a cohort of patients for 10 years from the onset of stroke through 3 distinct phases– Time to admission– Inpatient care– Long-term care
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Progress in Improving Stroke CareConclusion
Services have improved quality of life for stroke victims since report in 2005 (£5.5k per QALY). NICE threshold £30k so progress assessed as achieving VfM
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Advantages Allow the robust comparison of
counterfactuals to conclude on VfM Allow us to quantify the likely
outcome of recommendations on service reconfiguration
Add value for our clients Increased external profile
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Challenges
Technical output hard to explain to lay person in a short report– Teams have made innovative use of
appendices and web products
We need to convince our audience that results of models are robust and useful – Involve Department’s technical staff to provide
Civil Servants with assurance– Ensure robust internal and external quality
assurance processes
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Challenges
Resource and time intensive– True but good planning can ensure work meets
deadlines– Even simple models can provide insight
Lack of data– Ability to do primary research and data
gathering is limited so need to ensure that these approaches are planed in at the start and used where appropriate
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Challenges
Benefits – either financial or service improvements - may not accrue to the department incurring the cost– Our remit is to illustrate the potential
benefits to the exchequer or the economy
– Challenge to government in how this conflict can be resolved
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Next Steps for the NAO
Develop our capacity to use models in health studies and other areas
Increase engagement with academic community
Recruit a temporary academic research fellow under the ESRC placement scheme
Submit certain work for peer review
