Pounds, shillings and pence: Ways to Cost NHS complementary therapy services – The SEAT and BISCUIT studies

Abstract

Background To inform their decisions, commissioners need to know if particular services reduce NHS costs and procur cost savings elsewhere within the system. A review of service evaluations of NHS complementary therapy services found that most did not investigate the impact of these services on NHS costs such as GP consultations, hospital visits and medications. Two recent studies have attempted to tackle the challenges in economic evaluation of NHS complementary therapy services, using different approaches. The SEAT study evaluated an Alexander Technique (AT) service in a hospital pain clinic. The BISCUIT study focused on the economic evaluation of the Bristol Homeopathic Hospital. The aim of this presentation is to reflect on these two studies’ approaches to economic evaluation, compare their usefulness and present results. Methods The SEAT study recruited 43 service users via the hospital pain clinic who attended weekly Alexander Technique lessons over six consecutive weeks. They self-reported personal and NHS costs at the first session, six weeks and 3 months after baseline. As part of the BISCUIT study, 15 case participants who attended the Bristol Homeopathic Hospital and 19 community control participants were matched for GP practice, condition, age and sex and reported personal and NHS costs at five time points over 15 months. In addition, GP medical record data was extracted on NHS resource use and sick notes for all 34 BISCUIT participants. SEAT and BISCUIT data were priced using a variety of different sources (i.e. NHS reference costs, British National Formulary, Unit Costs of Health and Social Care). SEAT data were analysed for NHS and personal costs whereby standard weekly costs were calculated at three time points and compared. BISCUIT data were analysed from a NHS cost and societal cost perspective whereby annual costs for cases and controls were compared. Results For the SEAT study, we found that total costs for AT service users did not decrease between baseline (mean £55.53 [95% CI £39.97 to £71.10]) and three months (mean £61.19 [95% CI £14.89 to £107.49]). However NHS and personal costs associated specifically with pain reduced substantially from £27.43 (95% CI 19.26 to £35.60) to £11.68 (95% CI £4.55 to £18.81). Results for the BISCUIT study are still undergoing analysis. For both the SEAT and BISCUIT studies, we found that there was substantial variability. Conclusions The SEAT and BISCUIT studies are breaking new ground in finding commissioner friendly approaches to costing NHS complementary therapy services. At this conference, we would like to disseminate our learning so that future evaluators of NHS complementary therapy services can incorporate cost analyses into their research design. This would be of key interest to healthcare commissioners considering the funding of NHS complementary therapy services.