Establishing Value for Money

Aim

In 2009 Echotech commissioned a study to quantify the difference in cost between the Echotech Community Echo care pathway and traditional pathways. The aim thus being to answer the question of whether the Echotech pathway is more cost efficient than the other pathways that health service commissioners can utilise.

Method
A mathematical model was built showing the associated cost for 100 patients to go through each of the steps associated with three prevalent care pathways:
 
1 Echotech Community Echo pathway
2 Traditional Consultant Outpatient pathway
3 Hospital-Based Open Access Echo pathway

The starting point of the measured pathways was determined as the initial GP visit, with the end point of the pathway being the implementation of a Secondary Care outpatients treatment plan. In this way the measurements were commensurate with the definition of RTT and the 18 Week Pathway. The steps for each pathway were identified and a cost per event was assigned to each step based on published data.  Each step was scaled accordingly to account for 100 theoretical patients.  The total cost for each pathway was then found so that comparisons could be made. The integrity of the three pathways and the element costs were reviewed and agreed in an iterative fashion by a range of medical professionals and financial analysts. The resulting models were evaluated. 
  
Findings
The headline outcome was that the Echotech Community Echo pathway costs £12,324.91 for 100 patients to follow. The traditional Consultant Outpatient pathway costs £31,774.40 and the Hospital-based Open Access Echo pathway costs £13,856.45. The Echotech pathway represents a saving of 61.2% over the Traditional Consultant Outpatient pathway, and a saving of 11.1% over the Hospital-based Open Access Model. In terms of time, the Echotech pathway shows that the waiting time for the echo is less than 2 weeks if the Patient Management Centre is utilised.
 
Conclusion
The Echotech Community Echo pathway is more cost effective than the two widely used alternatives. When extrapolated to the catchment population of an NHS commissioning organisation, the outcome is a large financial saving.

Data Sources
1 GP Consultation Cost (£11.38) 
Appointment rate from Health Services Research, Family Practice Vol.19, No.5, 500-503, Oxford University Press, 2002.
2 Echotech tariff price 2009/10 for full echo service, including booking and reporting.
3 Echotech DNA rate (2%)
Echotech Patient Management Centre. Cumulative position at 10.06.09.
4 Referral to Cardiologist (9%)
Horsham Cardiac Interface Service. Actual cumulative patient referral rate to 01.05.09.
5 Cardiologist 1st Consultation (£189.00)
NHS National Tariff 2009/10. Outpatient Tariff for Consultant led, single professional first visit.
6 NHS Outpatients DNA rate (11%)
A look at non-attendance at outpatient appointments. S Jones and J Ford, HSJ, 19.02.09.
7 Maximum Echotech waiting time for Echo (2 weeks)
Echotech Quality Accounts. All PMC managed contracts to 10.06.09.
8 Echo in Outpatients clinic (£87.00)
Payment by Results Guidance for 2009/10. Non-mandatory price for transthoracic echocardiogram.
9 Market Forces Factor (MFF = 1.121460)
Payment By Results mean MFF for PCTs for 2008/09 provided by NHS Information Centre, 09.04.09

The full breakdown of these figures and calculations is available on request