Secondary Care Resources Research Articles

A lifetime economic model of mortality and secondary care use for patients discharged from hospital following acute stroke.

The long-term health-economic consequences of acute stroke are typically extrapolated from short-term outcomes observed in different studies, using models based on assumptions about longer-term morbidity and mortality. Inconsistency in these assumptions and the methods of extrapolation can create difficulties when comparing estimates of life-time cost-effectiveness of stroke care interventions. To develop a long-term model consisting of a set of equations to estimate the life-time effects of stroke care interventions to promote consistency in extrapolation of short-term outcomes. Data about further admissions and mortality was provided for acute stroke patients discharged between 2013 and 2014 from a large English service. This was combined with data from UK life tables to create a set of parametric equations in a model that use age, sex, and modified Rankin Scores to predict the life-time risk of mortality and secondary care resource utilisation including ED attendances, non-elective admissions, and elective admissions. A cohort of 1,509 (male 51%; mean age 74) stroke patients had median follow-up of seven years and represented 7,111 post-discharge patient years. A logistic model estimated mortality within twelve months of discharge and a Gompertz model was used over the remainder of the lifetime. Hospital attendances were modelled using a Weibull distribution. Non-elective and elective bed days were both modelled using a log-logistic distribution. Mortality risk increased with age, dependency, and male sex. Although the overall pattern was similar for resource utilisation, there were different variations according to dependency and gender for ED attendances and non-elective/elective admissions. For example, 65-year-old women with a discharge mRS of 1 would gain an extra 6.75 life years compared to 65-year-old women with a discharge mRS of 3. Over their lifetime, 65-year-old women with a discharge mRS of 1 would experience 0.09 less ED attendances, 2.12 less non-elective bed days and 1.28 additional elective bed days than 65-year-old women with a discharge mRS of 3. Using long-term follow-up publicly available data from a large clinical cohort, this new model promotes standardised extrapolation of key outcomes over the life course, and potentially can improve the real-world accuracy and comparison of long-term cost-effectiveness estimates for stroke care interventions. Data is available upon reasonable request from third parties.

82 - Secondary care resource utilisation in patients with high PDL1 and advanced non-squamous non-small cell lung cancer (NSq-NSCLC): a comparison of single agent pembrolizumab with combination chemotherapy + pembrolizumab

82 - Secondary care resource utilisation in patients with high PDL1 and advanced non-squamous non-small cell lung cancer (NSq-NSCLC): a comparison of single agent pembrolizumab with combination chemotherapy + pembrolizumab

The increasing burden of the 2-week wait colorectal cancer pathway in a single centre: the impact of faecal immunochemical tests.

Two-week wait (TWW) volume and colorectal cancer (CRC) detection pose an increasing challenge for NHS cancer services. Primary aims were to assess the introduction of faecal immunochemical tests (FIT) into clinical practice at our centre, the impact on TWW referral volume and CRC diagnoses, and to provide an update to previously published work. A secondary aim was to correlate FIT value and investigation. TWW CRC data following incorporation of FIT into clinical practice were analysed (1 June 2019-31 July 2021). Parameters assessed were monthly referral volume, CRC detection, primary care FIT volume and secondary care investigations. Referrals and CRC detection rates were compared with previously published data (2009-2019). Data relating to primary care FIT were collated from Berkshire and Surrey Pathology Services. TWW referrals increased 360% (2009-2020). CRC incidence decreased from 8.87% to 3.24%. Following incorporation into clinical practice, primary care FIT requests have increased to >450/month and accompanied 1,722/4,796 referrals. CRC incidence is static (3-4%). Patients with FIT <10µg Hb/g faeces undergo radiological imaging more commonly, whereas FIT-positive patients are more likely to undergo endoscopy, although the difference is not statistically significant. No significant change in CRC diagnosis was observed, despite increasing TWW referrals. Increasing utilisation of FIT in both primary and secondary care has helped maintain CRC detection while avoiding diagnostic delay. This study supports growing evidence highlighting the value of FIT in triage, referral and TWW investigation. FIT appears increasingly important for allocating secondary care resources (endoscopy), while guiding primary care referral. Additional low-cost strategies to determine prioritisation or reassurance (e.g. repeat FIT) require further evaluation.

Patterns of Healthcare Resource Utilisation of Critical Care Survivors between 2006 and 2017 in Wales: A Population-Based Study.

In this retrospective cohort study, we used the Secure Anonymised Information Linkage (SAIL) Databank to characterise and identify predictors of the one-year post-discharge healthcare resource utilisation (HRU) of adults who were admitted to critical care units in Wales between 1 April 2006 and 31 December 2017. We modelled one-year post-critical-care HRU using negative binomial models and used linear models for the difference from one-year pre-critical-care HRU. We estimated the association between critical illness and post-hospitalisation HRU using multilevel negative binomial models among people hospitalised in 2015. We studied 55,151 patients. Post-critical-care HRU was 11-87% greater than pre-critical-care levels, whereas emergency department (ED) attendances decreased by 30%. Age ≥50 years was generally associated with greater post-critical-care HRU; those over 80 had three times longer hospital readmissions than those younger than 50 (incidence rate ratio (IRR): 2.96, 95% CI: 2.84, 3.09). However, ED attendances were higher in those younger than 50. High comorbidity was associated with 22-62% greater post-critical-care HRU than no or low comorbidity. The most socioeconomically deprived quintile was associated with 24% more ED attendances (IRR: 1.24 [1.16, 1.32]) and 13% longer hospital stays (IRR: 1.13 [1.09, 1.17]) than the least deprived quintile. Critical care survivors had greater 1-year post-discharge HRU than non-critical inpatients, including 68% longer hospital stays (IRR: 1.68 [1.63, 1.74]). Critical care survivors, particularly those with older ages, high comorbidity, and socioeconomic deprivation, used significantly more primary and secondary care resources after discharge compared with their baseline and non-critical inpatients. Interventions are needed to ensure that key subgroups are identified and adequately supported.

Novel oral iron therapy for iron deficiency anaemia: How to value safety in a new drug?

Novel oral iron supplements may be associated with a reduced incidence of adverse drug reactions compared to standard treatments of iron deficiency anaemia. The aim was to establish their value-based price under conditions of uncertainty surrounding their tolerability. A discrete-time Markov model was developed to assess the value-based price of oral iron preparations based on their incremental cost per quality-adjusted life year (QALY) gained from the perspective of the NHS in the UK. Primary and secondary care resource use and health state occupancy probabilities were estimated from routine electronic health records; and unit costs and health state utilities were derived from published sources. Patients were pre-menopausal women with iron deficiency anaemia who were prescribed oral iron supplementation between 2000 and 2014. The model reflecting current use of iron salts yielded a mean total cost to the NHS of £779, and 0.84 QALYs over 12 months. If a new iron preparation were to reduce the risk of adverse drug reactions by 30-40%, then its value-based price, based on a threshold of £20 000 per QALY, would be in the region of £10-£13 per month, or about 7-9 times the average price of basic iron salts. There are no adequate, direct comparisons of new oral iron supplements to ferrous iron salts, and therefore other approaches are needed to assess their value. Our modelling shows that they are potentially cost-effective at prices that are an order of magnitude higher than existing iron salts.

Management of Low back pain in Saudi Arabia healthcare system. A Qualitative Study.

BackgroundPatients with chronic low back pain can contribute to a global socioeconomic burden. Current international recommendations emphasize that low back pain management should occur at the primary-care level. However, there is a lack of essential services for low back pain management at the primary-care level in Saudi Arabia. We explored the current state of low back pain management in Saudi Arabia from the perspective of spine surgeons and physiotherapists.MethodsA qualitative study with semi-structured interviews was conducted on spine surgeons and physiotherapists. A total of 17 healthcare workers, 8 spine surgeons (age range 28–49 years) and 9 physiotherapists (age range 30–49 years) participated in the study. Data were recorded and analyzed thematically.ResultsThree main themes were identified from the interview data that outlined current low back pain management in Saudi Arabia: clinical guideline availability and pathways of care, utilization of primary care services, and overutilization of secondary care resources.ConclusionsThis study suggests underutilization of primary care services and overutilization of secondary care services in Saudi Arabia. Therefore, the implementation of local clinical guidelines could improve patient care as well as reduce the cost of low back pain management.

Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case-Control Study in Sweden.

IntroductionAtopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by pruritic, eczematous lesions. Recent evidence suggests that AD may be a systemic disorder, implying that management of this disease extends beyond merely controlling symptoms associated with AD. Even though this disease is highly prevalent in children and patients typically present with mild-to-moderate symptoms, the disease burden is not well established.MethodsA large, retrospective cohort study of Swedish population data was conducted to compare the clinical burden in terms of healthcare resource use and direct medical costs for pediatric mild-to-moderate (pM2M) AD patients (≤ 14 years of age, N = 87,721) with matched controls. The burden of a severe AD cohort was also evaluated. Severity of AD was defined by treatment usage and systemic treatment was used as a proxy for severe AD. A robust approach was used by including any type of secondary care visits known to be more common in AD patients than in the general population; however, data for primary care visits were not available.ResultsFor healthcare resource use, the incidence rate ratio (pM2M AD versus reference cohort) of secondary care visits ranged from 1.56 to 2.35 during each of 5 years after AD onset (all p < 0.001), with largest differences seen in years 1–2. The average direct medical cost (SD) was €1111 (3416) and €524 (2446) in the pM2M AD and reference cohorts, respectively. The corresponding estimate in the severe AD cohort was €1906 (7067). Including all secondary care visits and pharmacy-dispensed medications, the pM2M AD cohort was shown to have an additional €118.9 million in direct medical costs over 5 years compared with the reference cohort.ConclusionsThis study shows significant clinical and economic burden of pM2M AD with important secondary care resource utilization, suggesting a need for further research to increase treatment options and improve the management of these patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-020-00470-z.

PCN344 End of Life Secondary Care Resource Use and Costs in Mycosis Fungoides and Sézary Syndrome: An Analysis of Hospital Episode Statistics

There are limited published data on the real-world management and outcomes of patients with Mycosis Fungoides (MF) and Sézary Syndrome (SS), particularly for end-stage disease. This study aimed to describe the end-of-life clinical pathway, healthcare resource utilisation (HCRU) and costs associated with MF and SS. Patients with ICD-10 diagnoses of MF (C84.0) or SS (C84.1) between 1-Oct-2010 and 31-March-2019 recorded in the National Health Service’s Hospital Episode Statistics (HES) database, who died in the same period, were included. Secondary care activity was described from diagnosis, including number of lines, types and duration of systemic (non-topical) treatments (of those available in HES). HCRU and costs per patient/week were evaluated for 6-monthly periods in the 24 months before death. During the study period, 554/1,737 (32%) patients with MF and 88/165 (53%) with SS died (MF: mean age at diagnosis=72 years, 65% male; SS: mean age=71 years, 48% male). Of patients who died, 46% with MF and 39% with SS had ≥1 treatment and 11% MF and 11% SS patients had ≥3 lines (≥70% received systemic anti-cancer treatments for each line). While the frequency of outpatient, Accident and Emergency and inpatient spells were relatively stable over time, the duration of inpatient stays increased towards end-of-life (mean duration of inpatient stays occurring 18-24 months prior to death=12 days [MF] and 16 days [SS]; mean duration in the 6 months prior to death=23 days [MF] and 24 days [SS]). Mean total cost of HCRU per patient/week ranged from £77 to £180 (MF) and £59 to £164 (SS) depending on the time period, with a 50-100% increase observed by the final 6 months of life. This study highlighted the significant burden of MF and SS prior to death, with many patients experiencing multiple systemic treatment switches and high resource use and costs.

Streamlining the management of TMJD – an audit of the appropriateness of referrals for TMJD received by the East Sussex Hospital Trust

Background: Temporomandibular joint disorder (TMJD) referrals from primary care make up a significant number of new patient referrals to OMFS departments. This audit aims to determine the appropriateness of these referrals, educate primary care providers, and streamline secondary care resources into patients who cannot be managed in primary care alone.

Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009.

BackgroundPrevious studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care.MethodsA retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009.ResultsA total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case.ConclusionsExtrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.

P90 Streamlining primary care referrals to an early inflammatory arthritis (EIA) clinic: distinguishing between patients with osteoarthritis and inflammatory arthritis

Abstract Background To use biochemical markers and ultrasound to differentiate between inflammatory and noninflammatory diagnoses in the early inflammatory arthritis (EIA) referral setting. Careful patient selection is crucial to ensure timely and efficient use of secondary care resources. Methods A retrospective audit of the EIA pathway was conducted over six months at two partnered district general hospitals in London in 2018. For each of the 75 patients studied, data collected included demographics, biomarkers of disease and inflammation, appointments dates, details of scans requested, and the clinical diagnosis made at the EIA appointment. Statistical tests included pairwise comparisons using Welch’s 2-sample t-test for continuous variables and two-sample chi squared tests for equality of proportions with continuity correction for categorical variables. Logistic regression models were used, incorporating age, inflammatory markers and serostatus. Goodness of fit was evaluated using the log likelihood method and McFadden’s pseudo-R2. Predictive modelling was carried out using the Caret package. Analysis was conducted in R (R v3.5). Results Over half of participants (59%) were diagnosed with non-inflammatory disorders; the most common diagnosis was osteoarthritis (31%). Rheumatoid Arthritis (15%) was most common amongst the 41% of Inflammatory arthritides (IA). Ultrasound confirmed the clinical diagnosis of IA vs non-IA with 70% accuracy. There were no significant differences between those with and without ultrasound evidence of synovitis in terms of age (p 0.25), CRP (p 0.22), ESR (p 0.59), RF (p 0.43) or CCP (p 1) positivity. This null is likely due to a small sample size and lack of statistical power. Comparison of patients with a clinical diagnosis of IA vs non-IA revealed significantly increased CRP (9.5 vs 4.2 p 0.01) and CCP positivity rates (22.5% vs 0%, p 0.003) in the inflammatory group, with no significant differences in age (p 0.45), ESR (p 0.24), or RF positivity rate (p 0.18). In those with a clinical diagnosis of osteoarthritis, there were a significantly higher age (55.0 vs 43.5, p 0.0009), lower CRP (3.2 vs 7.8, p 0.005), and lower ESR (9.2 vs 19.7, p 0.006). Neither RF (p 0.73) nor CCP (p 0.16) positivity rates differed significantly between osteoarthritis or other diagnoses. Conclusion It was demonstrated that even in small cohorts, simple predictive variables can be used to risk-stratify and assess the likelihood that a patient will have osteoarthritis rather than IA. It is shown that older age, lower ESR and lower CRP are indicators at differentiating IA from non-IA. Given the national high prevalence of osteoarthritis and the clinical uncertainty in distinguishing osteoarthritis from IA, ultrasound has significant value in the diagnostic work-up. Further research should attempt to predict eventual diagnosis from clinical characteristics alone to help general practitioners distinguish patients with IA from those with non-IA. Disclosures B.M. Jacobs None. N. Sarathchandra None. M. Karela None. L.E. Daniels None. N. Purkayastha None.

Violence-related knife injuries in a UK city; epidemiology and impact on secondary care resources

BackgroundThe incidence of knife-related injuries is rising across the UK. This study aimed to determine the spectrum of knife-related injuries in a major UK city, with regards to patient and injury characteristics. A secondary aim was to quantify their impact on secondary care resources. MethodsObservational study of patients aged 16+ years admitted to a major trauma centre following knife-related injuries resulting from interpersonal violence (May 2015 to April 2018). Patients were identified using Emergency Department and discharge coding, blood bank and UK national Trauma Audit and Research prospective registries. Patient and injury characteristics, outcome and resource utilisation were collected from ambulance and hospital records. Findings532 patients were identified; 93% male, median age 26 years (IQR 20–35). Median injury severity score was 9 (IQR 3–13). 346 (65%) underwent surgery; 133 (25%) required intensive care; 95 (17·9%) received blood transfusion. Median length of stay was 3·3 days (IQR 1·7–6·0). In-hospital mortality was 10/532 (1·9%). 98 patients (18·5%) had previous attendance with violence-related injuries. 24/37 females (64·9%) were injured in a domestic setting. Intoxication with alcohol (19·2%) and illicit drugs (17·6%) was common. Causative weapon was household knife in 9%, knife (other/unspecified) in 38·0%, machete in 13·9%, small folding blade (2·8%) and, unrecorded in 36·3%. InterpretationKnife injuries constitute 12·9% of trauma team workload. Violence recidivism and intoxication are common, and females are predominantly injured in a domestic setting, presenting opportunities for targeted violence reduction interventions. 13·9% of injuries involved machetes, with implications for law enforcement strategies.

A Retrospective Review of the Management of Vascular and Soft Tissue Complications in People Who Inject Drugs at a Tertiary Vascular Surgical Unit

Introduction - In the UK hospital admissions associated with skin,soft tissue and vascular infections (SSTVI) secondary to illicit opiod use have increased in the last 5 years. People who inject drugs (PWID) utilise a significant amount of secondary care resources and the extent of this has not been fully evaluated in the contemporary literature. The utilisation of femoral vessels for injection is indicative of long-term intravenous drug use as more easily accesible vessels in the hand and antecubital fossa become thrombosed. This study evaluates the demographics, presentation, subsequent management and outcomes of PWID presenting to a tertiary vascular unit in the UK with SSVTI. The region this work was undertaken experiences the highest number of PWID related admissions to hospital in the UK. Methods - Admissions to our hospital from Jan 2014 to Dec 2017 were collected for retrospective analysis. A total of 202 patients were admitted with a SSTVI in this time period. Presenting complaint, in-patient length of stay (LOS), receiving speciality, imaging modalities, microbiology, blood borne virus (BBV) status along with subsequent medical and surgical management were reviewed. Results - 69.3% of patients admitted with a SSTVI were male with the majority being in the age range of 40-60 (55.9%). Median LOS was 6 days (IQR 2-12.75), with 49.5% of patients being treated by the Vascular Surgical team, the rest being managed across medical, orthopaedic and general surgical teams. 30.7% of patients had USS of the SSVTI, 28.7% had a CT angiogram, 10.4% had a plain x-ray and 13.9% had both CT angiogram and USS. 48% of the patients tested positive for the Hepatitis C core antigen indicating current or recent exposure to the Hepatitis C virus. 16.3% of the patients had detectable levels of Hepatitis C viraemia on ribonucleic acid. 1% of patients were positive for HIV-1. 67 patients underwent groin exploration and drainage of an abscess with 27 also requiring ligation of a femoral pseudoanueysm. No patients underwent reconstruction of the femoral artery following ligation and there were 3 above knee amputations performed during the same in-patient episode. Conclusion - We have noted a significant increase in the number of patients presenting with SSVTI over the period of our study. This has had a significant impact on resources given the LOS and multidisciplinary input required to ensure a safe and timely discharge from hospital when dealing with PWID. All patients in whom a SSVTI is suspected in the groin should undergo a CT angiogram as the imaging modality of choice as this accurately identifies any vascular complications as well as the presence of foreign bodies which may potentially cause a needle stick injury to the surgical team. Ligation of femoral pseudoaneurysms generally does not result in patients requiring amputation, however, they are often claudicants as a result.

PDB48 COST AND CAPACITY EFFECTS OF HEALTHYWEIGHTHUB @ VIRTUAL HOSPITAL 2.0 IN FINLAND

HealthyWeighHub (HWH) is a multidisciplinary eHealth program for management of obesity implemented in the HealthVillage of the Helsinki University Hospital (HUS). HWH is free of charge for all Finns with obesity through clinician’s referral. We evaluated and predicted HWH’s cost-benefits (costs and capacity). PICOSTEPS reporting framework was applied. Patients: 1] Finnish patients receiving obesity intervention in HUS Specific Catchment Area (HUS ERVA) and 2] patients with a body mass index ≥ 30 kg/m2 in Finland nationally. Intervention: 12-month HWH (web-based program + virtual coach). Comparator: Conventional group coaching (CGC). Outcomes: Potential capacity freed (PCF, cost difference), capacity change. Settings: 1] Actualized PCF between 2016 to 2018 in HUS ERVA based on counterfactual estimation. 2] Predicted PCF at Finnish national level, if HWH was implemented gradually from 2018 to 2022 and the number of individuals with obesity was kept constant; based on modelling. Time: 1] Two and 2] five years, no discounting. Effects: Secondary care resource, patient co-payment and travelling costs. Perspective: Direct health service payer costs. HWH’s actualized PCF was €2.69 million compared to CGC over the two-year period in the HUS ERVA. If also the CGC had been supplemented with HWH instead, total PCF could have been €3.71 million. On a national level, treating 1% of individuals with obesity with CGC was predicted to cost €28.0 million in 2022. With HWH the predicted cost was €7.31 million, resulting in annual PCF of €20.7 million (€3.75/capita) in 2022 and cumulative five-year PCF of €57.5 million (€10.43/capita). Approximately 3.8-times more patients could be provided care with HWH than possible with CGC, assuming fixed budget. HWH is capacity-freeing and potentially cost-saving in comparison to CGC, and an efficient tool to combat the increasing obesity epidemic in Finland. HWH may also increase the availability and achievability of obesity-related services.

PCN119 - SECONDARY CARE RESOURCE UTILIZATION AND COST OF CARE AMONG FINNISH NON-SMALL CELL LUNG CANCER PATIENTS

Lung cancer is the most common cancer worldwide. In Finland, 2,500 people are diagnosed with lung cancer yearly. The majority, 80-85%, of all lung cancers are non-small cell lung cancers (NSCLC), which are commonly diagnosed at an advanced stage. In this study, we characterized secondary healthcare resource utilization and associated costs of Finnish NSCLC patients in a real-life clinical setting. The treatment lines and outcomes will also be characterized in subsequent complete analyses of Finnish NSCLC population. All adult patients with newly diagnosed NSCLC at the Hospital District of Southwest Finland between the years of 2013-2014, were included in the study. Data on resource use and costs was collected retrospectively from electronic healthcare records via the Turku Clinical Research Centre (TurkuCRC) database. Data was collected one year prior to diagnosis and one year after the diagnosis. A total of 464 NSCLC patients were included in the study. The mean number of annual outpatient visits per patient was 6.7 one year prior to diagnosis and 12.5 one year after the diagnosis. The mean number of inpatient visits during the pre-diagnosis year was 0.8 and 1.4 during the post-diagnosis year. The mean number of inpatient days per year was 3.8 and 10.0, respectively. One year prior to diagnosis the mean annual total costs of secondary care resource use were 5377€ and one year after the diagnosis 11423€. There was a clear increase in healthcare resource utilization and costs after the NSCLC diagnosis. NSCLC patients had a higher number of outpatient visits and inpatient stays during the post-diagnosis year, compared to the year before NSCLC diagnosis, which resulted over 2-fold increase in annual healthcare cost.

The SIMS trial: adjustable anchored single-incision mini-slings versus standard tension-free midurethral slings in the surgical management of female stress urinary incontinence. A study protocol for a pragmatic, multicentre, non-inferiority randomised controlled trial

IntroductionSingle-incision mini-slings (SIMS) represent the third generation of midurethral slings. They have been developed with the aim of offering a true ambulatory procedure for treatment of female stress urinary incontinence...

Clinical effectiveness and cost-effectiveness of foot orthoses for people with established rheumatoid arthritis: an exploratory clinical trial

Objectives: Foot orthoses are commonly prescribed as an intervention for people with rheumatoid arthritis (RA). Data relating to the cost-effectiveness of foot orthoses in people with RA are limited. The aim was to evaluate the clinical and cost-effectiveness of two types of foot orthoses in people with established RA.Method: A single-blind randomized controlled trial was undertaken to compare custom-made foot orthoses (CMFOs) and simple insoles (SIs) in 41 people with established RA. The Foot Function Index (FFI) was used to measure foot pain, disability, and functional limitation. Costs were estimated from the perspective of the UK National Health Service (NHS), societal (patient and family) perspective, and secondary care resource use in terms of the intervention and staff time. Effects were assessed in terms of health gain expressed as quality-adjusted life years (QALYs).Results: At baseline, 20 participants received a CMFO and 21 participants received an SI. After 16 weeks foot pain improved in both the CMFOs (p = 0.000) and the SIs (p < 0.01). However, disability scores improved for CMFOs (p < 0.001) but not for SIs (p = 0.40). The cost-effectiveness results demonstrated no difference in cost between the arms (CMFOs: £159.10; SIs: £79.10; p = 0.35), with the CMFOs being less effective in terms of cost per QALY gain (p < 0.001).Conclusions: In people with established RA, semi-rigid customized foot orthoses can improve pain and disability scores in comparison to simple insoles. From a cost-effectiveness perspective, the customized foot orthoses were far more expensive to manufacture, with no significant cost per QALY gain.

P31 Intelligence Based Information System (ibis) Reduces Respiratory Patients' Use Of Secondary Health Care Resources

Background IBIS is a database developed by South East Coast Ambulance Service (SECAmb) to facilitate communication of individual patient care plans between SECAmb, the Respiratory Care Team (RCT) and secondary care. It aims to reduce the number of patients conveyed to hospital. Aims and objectives The investigation aimed to establish the impact of IBIS on respiratory patients’ use of secondary care in our locality. Methods Respiratory patients uploaded into IBIS between May and November 2013 were included. Data were collected from the Patient Administration System including, number of A&E attendances and admissions in the three months preceding and three months after patient care plans were included in IBIS. Data were analysed with descriptive statistics and Wilcoxon Paired Test utilising SPSS version 22. Results 65 patients were included in the study. Table 1 demonstrates the impact of IBIS on A&E attendances and admissions. There was a significant reduction in admissions (p = 0.011). A reduction in A&E attendances was observed (p = 0.064). A sub-analysis of patients already utilising secondary care resources was undertaken. In this patient group a significant reduction in both A&E attendances (p = 0.000) and admissions (p = 0.000) was observed. Conclusions IBIS assists in reducing respiratory patients A&E attendances and admissions. The impact of IBIS is more profound in patients who have already utilised secondary health care resources.

Pharmacoeconomic study of chronic constipation in a secondary care centre.

The aim of this study was to measure any incremental costs or savings within the health system associated with the introduction of the new technology, prucalopride, for the management of chronic constipation. The study design was based on a budget impact analysis conducted by the National Institute of Clinical Excellence (NICE). To validate the findings of the NICE costing template, a case series audit capturing real world data was used to determine the financial impact of adopting prucalopride in 40 women suffering with chronic constipation. This facilitated the application of local unit costs to the resources used and determined whether the use of prucalopride, as an alternative treatment to laxatives, resulted in a reduction in the use of secondary care resources. Patients were treated with an average of 2.6 laxatives in the baseline (laxatives only) scenario. The total medication costs in the baseline (laxatives only) and the new treatment (prucalopride) scenario amounted to €17,440.84 and €18,417.62, respectively. There was a significant reduction in the number of investigations and procedures in the 12months after commencing prucalopride, with cost savings of €41,923.28 (€1,048.08 per patient per year) demonstrated. Input cost variables were adjusted as part of sensitivity analysis. This study validated the findings of the NICE costing template and suggests that the use of prucalopride for the treatment of chronic constipation in women refractory to laxatives has the potential to reduce secondary care resource use and hence led to cost savings.

PTU-148 Healthcare Costs And Quality Of Life Associated With Acute Upper Gastrointestinal Bleeding In The Uk

IntroductionAcute upper gastrointestinal bleeding (AUGIB) accounts for over 70,000 hospital admissions in the UK annually. Its incidence is likely to rise due to an ageing population and increasing burden of...