Cost-effective commissioning of colorectal cancer care: An assessment of the cost-effectiveness of improving early diagnosis

Transcription

1 Cost-effective commissioning of colorectal cancer care: An assessment of the cost-effectiveness of improving early diagnosis London Public Health Knowledge & Intelligence Network 31 January 2017 Panos Zerdevas, Senior Economist PHE

2 Contents PHE Health Economics team Commissioning Framework CRC project Findings Local example 2 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

3 Background: Health economics team 1. Building Capacity Objectives 2. Making the case for investment in prevention and early intervention 3.Supporting the development of tools and resources Limited in-house capacity Commissioning Framework 3 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

4 Background: Health Economics Commissioning Framework Academics and commercial partners that we can commission projects from very quickly Projects aimed largely at supporting local commissioners to make the case for prevention and early intervention. One of the projects: colorectal cancer 4 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

5 Outputs of the CRC project Two outputs: A user-friendly tool and An accompanying report 5 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

6 Why Colorectal Cancer (CRC)? CRC is a major cause of morbidity and mortality in England Despite improvements, five-year survival rates in England are worse than in peer countries CRC outcomes in England (UK) lag behind peer countries in both level and pace of improvement Australia Sweden Canada Norway Denmark UK CRC age standardised five-year relative survival Survival rate, %, , England Colon 90 Rectum E Year E Year SOURCE: Is England closing the international cancer gap in survival, Walters et al, Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

7 CRC is often diagnosed at relatively late stages The survival rates for CRC are significantly higher when cancers are diagnosed earlier NHS costs are also much lower 7 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

8 Patients diagnosed through screening and elective routes have higher survival rates Three routes to diagnosis: Screening Elective Emergency 8 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

9 Our aim is to shift patients from later stage, high intensity of treatment presentations to earlier stage, lower intensity of treatment presentations Stage Route to diagnosis Screening Elective Emergency 1 Better Outcomes Worse outcomes 9 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

10 There is room for improvement Comparisons with other countries and within England illustrate the opportunities to achieve earlier diagnosis: 13% of cases diagnosed at stage 1. In Canada, 17% 25% of cases diagnosed in A&E. In Sweden, 17% 20% variation in screening rates across the country The annual rate of colonoscopy and flexible sigmoidoscopy procedures ranged from 106 to 207 per 10,000 persons 10 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

11 Interventions to improve screening Improving GP involvement in the CRC screening process Providing informative community advice about the screening process Better collaboration with regional and national stakeholders Improve elective route symptom awareness encourage people to discuss relevant symptoms improve triage, and increase access to diagnostics. 11 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

12 Misaligned incentives Cost effectiveness versus immediate cost savings Siloed budgets Impact on waiting times for diagnostics Real or perceived capacity constraints (GPs) Lack sufficient confidence(gps) Time constraints (GPs) 12 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

13 CRC tool The CRC tool provides information that helps commissioners make the right investment decisions Route to diagnosis Cost of treatment and intervention for CRC, m Do nothing Take action Total # of CRC cases # new CRC cases per year # of CRC cases per weighted population # of CRC diagnosis per year # of CRC diagnosis by stages per year E.g. GP training Screening comms campaign Increase colonoscopy usage Stage at time of diagnosis Before After Stage 1 Stage 2 Stage 3 Stage Time 13 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

14 Local Example: Nene CCG Intervention: Distribution of GP endorsement letters together with enhanced leaflet Screening uptake rate: 12% increase 6,383 extra patients are screened 319 extra colonoscopies 16 people diagnosed with CRC each year Total cost 240k/Net cost 142k Health Benefits: By year 10, 5 less people each year with stage 4 (150 LY gained ) Cost per healthy life year gained: 950 per healthy life year 14 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network

15 Thank you For more information on our products: Website: HE Web Page: 15 Cost-effective commissioning of colorectal cancer care London Public Health Knowledge & Intelligence Network