One of the themes that IMPRESS is developing is value - what is the best value that can be gained from the respiratory programme budget in terms of improving patient outcomes?  We have now published our guide to the Relative Value of COPD interventions.  

In summary:

The study modelled a population of 300,000 including about 12,000 at risk of COPD of varying degrees of severity. A technique called decision conferencing was then used to assess the effectiveness of different types of treatment and the number of people who could benefit. This enabled the researchers to compare the value of different treatment scenarios in terms of both cost and their use to patients.

It found that there is “substantial overtreatment” of inhaled medicines for patients with mild to moderate disease and that in some cases this could create health problems. In particular, it warns of the risks of prescribing “triple therapy” - multiple inhaled treatments – both because of the risk of causing harm and because of unnecessarily high costs.

It also found that programmes of pulmonary rehabilitation – combining exercise, education and self-management – were particularly cost-effective ways of improving patient outcomes but are under-supplied in many parts of the country.

The Executive Summary and  full report, IMPRESS Guide to the relative value of COPD interventions:a population-based approach to improving outcomes for people with chronic obstructive pulmonary disease based on the cost of delivering those outcomes, is available at IMPRESS publications.  Each appendix is also available as a separate pdf in case you want to share specific aspects with colleagues, such as QALY data.

See here.

See here for BMJ Editorial

Muir Gray.  Optimising the value of interventions for populations. BMJ 2012;345:e6192

See : Looking for value in hard times. How a new approach to priority setting can help improve patient care while making savings. The Health Foundation, Aug 2012 for further information about the methodology.  This report from the Health Foundation describes how NHS Sheffield used the same approach that they have called called Star (‘socio-technical allocation of resources’), to re-allocate resources within its eating disorder services. 

As clinical commissioning groups in England begin to take on their new responsibilities, they will need tools that help them to take difficult disinvestment decisions. This report describes a methodology to inform rational decision making – and its application in practice.
“The Health Foundation is currently developing a toolkit to use Star for analysing local data on health spending and population health needs. This is being piloted with CCGs, and will be made freely available to download…….The LSE now wants to link the Star approach to exploring unwarranted variation in healthcare, using the NHS Atlas. Variations indicate scope for improving benefits without increasing total costs, Professor Bevan believes, and they therefore could be a key source of information for CCGs in responding to the Nicholson challenge” p20