Noel BaxterCo-lead NHS London Respiratory Team

Measuring value in COPD

Patient outcome measures vs. the provider process or outcome

Health OutcomesPatient definedbundle of care

CostValue=

Health Outcomes Cost of delivering

Outcomes

Porter ME; Lee TH NEJM 2010;363:2477-2481; 2481-2483

We know what interventions are good value – when they are done in the right way

Triple Therapy

£35,000-£187,000/QALY

LABA

£8,000/QALY

Tiotropium

£7,000/QALY

Pulmonary Rehabilitation

£2,000-8,000/QALY

Stop Smoking Support with pharmacotherapy £2,000/QALY

Flu vaccination £1,000/QALY in “at risk” population

We know how to allocate resource at population level

http://www.impressresp.com/index.php?option=com_content&view=article&id=167:impressions-28-relative-value-of-copd-interventions&catid=11:impressions&Itemid=3

Patient outcomes dependent on multiple providers

Hospital CCG & Community

http://www.londonhp.nhs.uk/publications/copd/copd-profiles-2012/

Increasing appropriate admissions

Using general practice data to show value across the pathway

The low value pyramid

and hospital providers !

What ‘reliable’ outcome measure can we start with ?

Prevalence of smoking in long-term conditions to be included for informational purposes

Patient facing outcome standard results in London