OTs need to grasp economic evaluation in health and social care

Genevieve Smyth, Mary Morley,

Sue Parkinson

Introduction

• What is economic evaluation and why is it important?• What OT economic evaluations currently exist?• How do we identify and measure costs and

consequences?• How do we move this agenda forward?

What is economic evaluation?

What is economic evaluation?

The comparative analysis of alternative courses of action in terms of their costs and consequences. It involves measuring and comparing for example, the costs of interventions A and B with the consequences of interventions A and B. The information produced is designed to enable decision making in health and social care. (Drummond et al 2005)

Its basic tasks are to identify, measure, value and compare all relevant costs and consequences. (Byford 2012)

If the clinical question is “Does this intervention work?”, the economic question is “Is it worth it?” (Knapp 2013)

Why is economic evaluation important?

Why is economic evaluation important?

• Scarcity –there are not enough resources to meet all of society’s needs or wants (Knapp 2013)

• Impact of recession –increased scrutiny of funding decisions particularly from the public purse

• Efficiency savings in the NHS of 20% of the NHS budget.• Efficiency savings in social care of up to 30%• Impact of demographics – ageing population will

increase demand for health and social care -over 85s consume majority of health and social care funding (Imison 2012)

Why is economic evaluation important?

• It helps make choices in a rational, explicit and transparent manner (Byford 2012)

• Devoting resources to one service means forgoing the benefits that would have arisen by funding another (Byford 2012)

• “OT services cost money,

usually tax payers money that could

be spent on other effective services

if our services are not effective”

(Bannigan 2004)

What OT economic evaluations exist?

Engaging people with psychotic conditions in primary care and OT (Cook, Howe 2003)

OT compared to social work assessment for older people (Flood et al 2004)

OT for work related major depression (Schene et al 2007)

Investment in housing adaptations, improvements, equipment (Heywood, Turner 2007)

OT to promote mental wellbeing of older adults (NICE 2008)

Community OT for older patients with dementia and their care givers (Graff et al 2008)

OT led lifestyle approach for panic disorder in primary care (Lambert et al (2010)

What OT economic evaluations exist?

..and more in the pipeline.... (HOVIS –Home Visits After Stroke – Drummond et al 2012)

http://eprints.nottingham.ac.uk/1766/

Also Logan P – UKOTRF Research Priority Grant 2008- A study of the long term economic consequences of short term stroke OT.

http://www.cot.co.uk/sites/default/files/grant_recipients/public/rpg-pl-abs-exec-sum.pdf

If you were carrying out an economic evaluation,

what costs might

you count?

Identifying and measuring costs• From whose perspective?

• Providers perspective –staff time, premises, heating, lighting, equipment/manuals, supervision, training

• Published unit costs per OT contact – Personal Social Services Research Unit e.g. Band 5 OT –cost per contact £74 (2011)

• Service user/family perspective – productivity losses, time, travel costs, childcare costs

• Wider society perspective –knock on effect on other services related to welfare and benefits, use of GP

• Opportunity costs – the cost of an alternative

that must be forgone in order to pursue a

certain action

What consequences (intended and unintended)

of interventions might you measure?

Identifying and measuring consequences

• Measurable improvement / maintenance/slowing of deterioration in the service users physical, psychological, social, emotional or occupational functioning

• Disease specific outcome measures –have direct clinical relevance but do not allow comparisons across illness areas (McCrone 2012)

• Utility measures preferred– a generic measure that combines quality and quantity of life e.g QALY –quality adjusted life year –used by NICE

• Most common health measure EQ5D (EuroQol), SF-36 and in social care the ASCOT (Knapp 2013)

• Use of retrospective data, prospective data or economic modelling

Imagine you have an idea for a new OT service

(call it Service 2)

You want to sell/recommend it so that it replaces today’s usual OT service

(call it Service 1)

The decision maker has a limited budget. What will she want to know before deciding whether to purchase the new

service?

(Knapp 2013)

• Does this new service work? (Effect on user’s needs, functioning, quality of life)• Is it more effective than the current service?• Is it affordable? (Costs of service and other services used, effect on employment)• Is it cheaper than the current service?• Is it more cost effective than the current service?• Trade offs -Is it worth it? (Is the intervention more effective but also more costly?)

(Knapp 2013)

What can we do now to move this agenda forward?

Moving the agenda forward

• Routine use of outcome measures including pre and post data

• Standardised care pathways, manualisation• Single cases, modelling• Using the generic tools e.g. EQ5D, SF-36, ASCOT• Including economic evaluation in research activity• Making friends with health economists• Learn more about economic evaluation• Read economic evaluations• Reconsider the balance between qualitative and

quantitative research/evaluation in the profession

Summary

• What economic evaluation is and why it’s important• What OT economic evaluations currently exist• Identifying and measuring costs and consequences• What we can do now to move this agenda forward

Genevieve.Smyth@cot.co.uk

Mary.Morley@swlstg-tr.nhs.uk

References

Bannigan K (2004) Occupational therapy is not a leisure pursuit. BJOT, 67 (4) 147

Byford S (2012) Introduction to economics, health economics and economic evaluation. Presentation at Institute of Psychiatry Economic Evaluation in Mental Health Short Course, September 2012.

Cook S, Howe A (2003) Engaging people with enduring psychotic conditions in primary mental health care and OT, BJOT, 66 (6) 236-246

Drummond et al (2005) Methods for the economic evaluation of healthcare programmes, third edition. Oxford: Oxford University Press.

Flood C et al (2004) OT compared with social work assessment for older people. An economic evaluation alongside the CAMELOT RCT. Age and Ageing, 34 (1), 47-52

Graff et al (2008) Community OT for older patients with dementia and their care givers: cost effectiveness study, BMJ, 336 (7636) 134-138

Heywood F, Turner L (2007) Better outcomes, lower costs. Implications for health and social care budgets of investment in housing adaptations, improvements, equipment –a review of the evidence. London: office of Disability issues

References

Imison C (2012) Ideas that change healthcare. Overview –Future trends. London: the Kings Fund

Knapp M (2013) Economic evaluation and reablement. Presentation on behalf of LSE and NIHR, Birmingham, January 2013.

Lambert et al (2010) Cost effectiveness analysis of an OT led lifestyle approach and routine GP’s care for panic disorder. Social Psychiatry and Psychiatric Epidemiology, 45/7 (741-750)

McCrone P (2012) What outcomes should we use in mental health economic evaluations; condition specific, monetary ,measures or QALYs? Presentation at IoP Economic Evaluation in Mental Health Short Course, September 2012.

NICE (2008) OT interventions and physical activity interventions to promote the mental wellbeing of older adults in primary and residential care. London: NICE.

Schene et al (2007) Adjuvant OT for work related major depression works: randomised trial including economic evaluation. Psychological Medicine, 37 (3) 351-362