By analysing the results from stakeholder decision conferences along with the STAR tool, we empowered ICSs to efficiently allocate resources for COPD patients and maximise value within limited funding constraints.
Integrated Care Systems (ICSs) face the challenge of allocating resources to better meet the health and healthcare needs of their population. This requires ICSs to understand the value of different interventions across the entire disease pathway, including interventions for prevention that affect the wider determinants of health as well as treatment. The Health Economics Unit used the STAR tool, a publicly and freely available tool, to empower ICSs to understand and undertake their own stakeholder-inclusive, in-depth allocative efficiency analysis for COPD so that they can reallocate resources to the best effect.
We brought together patients and stakeholders involved in providing and receiving care on a pathway to participate in decision conferences. These meetings were typically the first time that all who provided care on the pathway met in the same room at the same time and were designed to identify the interventions that could reasonably be taken forward by the ICS to improve the value of the COPD pathway.
We provided estimates of the activity and associated costs of each intervention and searched the literature for estimates of their health benefits in quality-adjusted life years (QALYs, a way of measuring how an intervention lengthens and improves a patient’s life).
Further decision conferences allowed stakeholders to agree on estimates of the relative benefit, informed by the literature. We then combined this with the costs of each intervention to understand an intervention’s value. This was then plotted in easy-to-interpret visualisations of where the value lies and used to facilitate conversations as to what improvements could be made.
So far, we have undertaken decision conferences with three ICSs and are producing a comprehensive report for each of them, detailing which interventions deliver the highest value in their ICS.
Our work on the COPD pathway will enable each ICS to align their pathway to deliver the most value for the limited funding available – providing the right amount of the right care. It will enable them to build consensus in the ICS on the future funding of the COPD pathway.
Additionally, we’ll be publishing a national report to share our learning and make recommendations on how resources should be allocated to deliver the most benefit to patients.
Tools and training materials will be made available for the NHS more widely so that others can use the technique.
“I think it was a really helpful discussion and helped to set the scene for how we make plans for next year. I think this will be widely celebrated and taken on across the system.“ Komal Gorania – Senior Commissioning Manager