NHS CLINICAL COMMISSIONERS
Focusing on prevention and early diagnosis, the case studies in this publication demonstrate the impact clinical commissioning groups are making in a wide range of areas including mental health care, early diagnosis of cancer and stroke prevention. They show how CCGs are taking the lead in preventing illness and the causes of ill health – and working to keep people out of hospital where possible; how they are helping to ensure that people are diagnosed earlier and given the support that they need; and they are working across boundaries to build on what people want and need to help them lead longer, healthier lives. More specifically the case studies provide examples of: working proactively with older people living with frailty; addressing preventable early deaths; supporting people to prevent and manage diabetes; reducing hospital admissions in people with COPD; managing c. difficile infections in the community; improving access to health services for homeless people; taking a strategic approach to stroke prevention; addressing early diagnosis of cancer; earlier diagnosis and prevention of HIV; improving early diagnosis and treatment of people with atrial fibrillation; working with the voluntary sector; impact of Living Well; and social prescribing to improve outcomes.
SAMPSON Christopher, et al
Introduction: Occupational therapy interventions, such as home visits, have been identified as being resource-intensive, but cost-effectiveness analyses are rarely, if ever, carried out. The authors sought to estimate the cost-effectiveness of occupational therapy home visits after stroke, as part of a feasibility study, and to demonstrate the value and methods of economic evaluation.
Method: The authors completed a cost-effectiveness analysis of pre-discharge occupational therapy home visits after stroke compared with a hospital-based interview, carried out alongside a feasibility randomised controlled trial. Their primary outcome was quality-adjusted life years. Full cost and outcome data were available for 65 trial participants.
Findings: The mean total cost of a home visit was found to be £183, compared with £75 for a hospital interview. Home visits are shown to be slightly more effective, resulting in a cost per quality-adjusted life year of just over £20,000.
Conclusion: The author's analysis is the only economic evaluation of this intervention to date. Home visits are shown to be more expensive and more effective than a hospital-based interview, but the results are subject to a high level of uncertainty and should be treated as such. Further economic evaluations in this field are encouraged.