Dataset Information

Modelling the cost-effectiveness of pay-for-performance in primary care in the UK.

ABSTRACT:

Background

Introduced in 2004, the United Kingdom's (UK) Quality and Outcomes Framework (QOF) is the world's largest primary-care pay-for-performance programme. Given some evidence of the benefits and the substantial costs associated with the QOF, it remains unclear whether the programme is cost-effective. Therefore, we assessed the cost-effectiveness of continuing versus stopping the QOF.

Methods

We developed a lifetime simulation model to estimate quality-adjusted life years (QALYs) and costs for a UK population cohort aged 40-74 years (n?=?27,070,862) exposed to the QOF and for a counterfactual scenario without exposure. Based on a previous retrospective cross-country analysis using data from 1994 to 2010, we assumed the benefits of the QOF to be a change in age-adjusted mortality of -3.68 per 100,000 population (95% confidence interval -8.16 to 0.80). We used cost-effectiveness thresholds of £30,000/QALY, £20,000/QALY and £13,000/QALY to determine the optimal strategy in base-case and sensitivity analyses.

Results

In the base-case analysis, continuing the QOF increased population-level QALYs and health-care costs yielding an incremental cost-effectiveness ratio (ICER) of £49,362/QALY. The ICER remained >£30,000/QALY in scenarios with and without non-fatal outcomes or increased drug costs, and under differing assumptions about the duration of QOF benefit following its hypothetical discontinuation. The ICER for continuing the programme fell below £30,000/QALY when QOF incentive payments were 36% lower (while preserving QOF mortality benefits), and in scenarios where the QOF resulted in substantial reductions in health-care spending or non-fatal cardiovascular disease events. Continuing the QOF was cost-effective in 18%, 3% and 0% of probabilistic sensitivity analysis iterations using thresholds of £30,000/QALY, £20,000/QALY and £13,000/QALY, respectively.

Conclusions

Compared to stopping the QOF and returning all associated incentive payments to the National Health Service, continuing the QOF is not cost-effective. To improve population health efficiently, the UK should redesign the QOF or pursue alternative interventions.

SUBMITTER: Pandya A

PROVIDER: S-EPMC6114231 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Modelling the cost-effectiveness of pay-for-performance in primary care in the UK.

Pandya Ankur A Doran Tim T Zhu Jinyi J Walker Simon S Arntson Emily E Ryan Andrew M AM

BMC medicine 20180829 1

<h4>Background</h4>Introduced in 2004, the United Kingdom's (UK) Quality and Outcomes Framework (QOF) is the world's largest primary-care pay-for-performance programme. Given some evidence of the benefits and the substantial costs associated with the QOF, it remains unclear whether the programme is cost-effective. Therefore, we assessed the cost-effectiveness of continuing versus stopping the QOF.<h4>Methods</h4>We developed a lifetime simulation model to estimate quality-adjusted life years (QA ...[more]

PMID: 30153827

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Dataset Information

Modelling the cost-effectiveness of pay-for-performance in primary care in the UK.

Background

Methods

Results

Conclusions

Publications

Modelling the cost-effectiveness of pay-for-performance in primary care in the UK.

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