PNS63 A Longitudinal Study to Identify Potentially Low-Value Clinical Procedures Using Hospital Episode Statistics Linked to Deprivation and Ethnicity in England, 2014/15-2018/19

Abstract

It is important that surgery is effective and good value for money. Different methods have been used to identify ‘low value’ surgical procedures for which use should be reduced or stopped; for example, reviewing current evidence/guidelines, or stakeholder consultation. We investigated whether high geographical or temporal variation in surgery rates in England might indicate uncertainty about their effectiveness or cost-effectiveness, potentially identifying them as ‘low value’. Longitudinal observational study of surgical procedures in England using Hospital Episode Statistics, 2014/15-2018/19, adjusted for age, sex, deprivation, and ethnicity using indirect standardisation. Procedures were defined by 3-character OPCS-4 codes. We highlighted surgeries in the top 5% for growth in surgery rates (2014/15-2018/19) and/or systematic component of variation (2018/19) and conducted a literature review of the evidence supporting these procedures. High temporal or geographical variation was associated with uncertainty in the evidence base: In five cases, it was unclear whether surgery was more cost-effective than non-surgical interventions (e.g. radiofrequency denervation of the facet joint); for another five procedures there was evidence that surgery is effective, but the most cost-effective method was unclear (e.g. bariatric surgery for obesity). Deep brain stimulation was recommended by NICE in particular circumstances, and there was little evidence about pressure manometry. Some observed variation was due to coding anomalies, highlighting the limitations of the OPCS system for research. Most procedures had not been previously identified as potentially ‘low value’ by other methods. Exploring temporal and geographical variation is a potential method of identifying clinical uncertainty about surgery. This type of analysis could be carried out on a regular basis to quickly identify increasing use of uncertain procedures. Early recognition could facilitate better regulation (e.g. only in trials) to generate evidence on cost-effectiveness before potentially ‘low value’ procedures become established in clinical practice.