Social return on investment analysis of a physiotherapy-led service for managing osteoarthritis in primary care

Abstract

BackgroundOver 8·75 million people in the UK live with osteoarthritis, which has major social and economic costs. Although the current approach to managing this condition in primary care is suboptimal, any quality improvement must deliver value for money. Social return on investment (SROI) is a cost-benefit analysis that captures wider social benefits. Here, we describe a SROI analysis of a physiotherapy-led service (rather than the usual general practitioner [GP]-led model) delivering National Institute for Health and Care Excellence (NICE) guidance for managing osteoarthritis in six GP practices. MethodsSROI analysis was undertaken to determine the inputs, outputs, and outcomes associated with the intervention. These data were used to calculate a SROI ratio, which determined the level of social value created for every £1 of investment. To mitigate the risk of overclaiming any benefits created by the service, the calculation used conservative values and accounted for deadweight, displacement, drop-off, and attribution. A sensitivity analysis was performed and the SROI was externally validated. FindingsThe SROI analysis showed that a physiotherapy-led service that delivers advice in line with NICE guidance created levels of social value that were greater than the cost of investment. Every £1 invested into the service resulted in a return of £2·43 to £4·03 in social value. The benefits (or outcomes) that patients gained from using the service were increased levels of physical activity, improved physical and mental health, reduced pain, and the saving in money and time spent travelling by accessing a local (GP-based) service. Outcomes for the National Health Service (NHS) were a reduction in health utilisation (eg, fewer GP consultations and secondary referrals) and the saving gained from the levels of weight loss seen in patients (ie, savings dispersed within the wider health system). InterpretationSROI analysis shows that a physiotherapy-led service in primary care that delivers NICE guidance for managing osteoarthritis created an SROI for patients and the NHS. The service delivered benefits to patients, reduced health utilisation elsewhere in the system (eg, GP workload), and delivered value for money. SROI can provide a useful approach to support funding bodies to determine cost-effectiveness for commissioning services in health care. FundingHealth Innovation Network.