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Does use of point of care testing improve cost effectiveness of the NHS Health Checks programme in the primary care setting? A cost minimisation analysis

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Title: Does use of point of care testing improve cost effectiveness of the NHS Health Checks programme in the primary care setting? A cost minimisation analysis
Authors: El-Osta, A
Woringer, M
Pizzo, E
Verhoef, T
Dickie, C
Ni, Z
Huddy, J
Soljak, M
Hanna, G
Majeed, A
Item Type: Journal Article
Abstract: Objective: To determine if use of Point of Care Testing (POCT ) is less costly than laboratory testing to the NHS in delivering the NHS Heath Chec k (NHSHC) programme in the primary care setting Design: Observational study and theoretical mathematical mo del with micro-costing approach Setting: We collected data on NHSHC delivered at 9 general practices (7 using POCT; 2 not using POCT). Participants: We recruited 9 general practices offering NHSHC, a nd a Pathology Services Laboratory in the same area. Methods: We conducted mathematical modelling with permutatio ns in the following fields: provider type (HCA or nurse), type of test performe d (total cholesterol with either lab fasting glucose or HbA1c), consumables costs and va riable uptake rates including rate of non-response to invite letter and rate of missed (D NA) appointments. We calculated Total Expected Cost (TEC) per 100 invites, number of NHSH C conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based p athways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters. Main outcome measures: We collected data on cost, volume and type of path ology services performed at seven general practices using POCT and a Pathology Services Laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices. Results: TEC of using POCT to deliver a routine NHSHC is low er than the laboratory-led pathway with savings of £29 per 100 invited patient s up the point of CVD risk-score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DN A appointment. Conclusions: TEC of using POCT to deliver an NHSHC in the prima ry care setting is lower than the laboratory-led pathway. Using POCT minimiz es DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.
Issue Date: 15-Aug-2017
Date of Acceptance: 19-May-2017
URI: http://hdl.handle.net/10044/1/48618
DOI: https://dx.doi.org/10.1136/bmjopen-2016-015494
ISSN: 2044-6055
Publisher: BMJ Publishing Group
Journal / Book Title: BMJ Open
Volume: 7
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Keywords: NHS health check
general practice
mathematical modelling
point of care
Publication Status: Published
Article Number: e015494
Appears in Collections:Division of Surgery
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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