Abstract
BackgroundDemand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population. More services are required to meet demand and ensure patients are seen within clinically recommended timeframes.MethodsA discrete event simulation model was developed to project endoscopy waiting list outcomes for two large metropolitan health services encompassing 8 public hospitals in Australia. The model applied routinely collected health service data to forecast the impacts of future endoscopic demand over 5 years and to identify the level of service activity required to address patient waiting times and meet key policy targets. The approach incorporated evidence from the literature to produce estimates of cost-effectiveness by showing longer term costs and Quality Adjusted Life Years (QALYs) associated with service expansion.ResultsThe modelling revealed that doing nothing would lead to the number of patients waiting longer than clinically recommended doubling across each health service within 5 years. A 38% overall increase in the number of monthly procedures available was required to meet and maintain a target of 95–98% of patients being seen within clinically recommended timeframes to the year 2021. This was projected to cost the funder approximately $140 million in additional activity over a 5 year period. Due to improved patient outcomes associated with timely intervention, it was estimated that the increased activity would generate over 22,000 additional QALYs across the two health services. This translated to an incremental cost-effectiveness ratio of $6467 and $5974 per QALY for each health service respectively.ConclusionsDiscrete event simulation modelling provided a rational, data based approach that allowed decision makers to quantify the future demand for endoscopy services and identify cost-effective strategies to meet community needs.
Highlights
Demand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population
The base case model predicted an increase in long wait patients by 46% for health service A (HSA) and 97% for health service B (HSB) (Table 1) between 2017 and 2021, assuming no increases to the number of endoscopy procedures available
Patient outcomes began to dramatically improve but improvement was inconsistent across categories and did not allow for clinically recommended wait times to be met within modelled targets
Summary
Demand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population. Health services are increasingly utilizing information technology, including electronic health records, to capture accurate and comprehensive information across all levels of patient interactions with the system [1]. Health related apps and wearable technology provide a repository of data, with implications for research still evolving. Emerging is the potential for Blockchain technology to create immense, decentralized, patient generated health databases that are updated in real time [2]. The use of routinely collected administrative health data has the potential to transform health service planning. The wealth of available data can provide decision makers with a rich and constantly evolving understanding of the broader system which in turn enhances their ability to plan for and deliver effective and efficient services
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