FreeStyle Libre Flash Glucose Monitoring system for people with type 1 diabetes in the UK: a budget impact analysis

INTRODUCTION: This study aims to estimate the budget impact of increased uptake of the FreeStyle Libre Flash Glucose Monitoring system in people with type 1 diabetes mellitus (T1DM) in the UK. RESEARCH DESIGN AND METHODS: A budget impact model was developed, applying real-world data collected in the Association of British Clinical Diabetologists (ABCD) FreeStyle Libre Nationwide Audit. Costs of diabetes glucose monitoring in a T1DM population (n=1790) using self-monitoring of blood glucose (SMBG) or the FreeStyle Libre system were compared with a scenario with increased use of the FreeStyle Libre system. RESULTS: The ABCD audit demonstrates FreeStyle Libre system use reduces diabetes-related resource utilization. The cost analysis found that higher acquisition costs are offset by healthcare costs avoided (difference £168 per patient per year (PPPY)). Total costs were £1116 PPPY with FreeStyle Libre system compared with £948 PPPY with SMBG. In an average-sized UK local health economy, increasing FreeStyle Libre system uptake from 30% to 50% increased costs by 3.4% (£1 787 345-£1 847 618) and when increased to 70% increased by a further 3.3%. CONCLUSION: Increased uptake of the FreeStyle Libre system in the T1DM population marginally increases the cost to UK health economies and offers many system benefits

Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study

YesPayment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services. Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level. The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1108, p<0001, 95% CI 1059 to 1160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings. Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services

Enrolled smokers per 1,000 adult population for intervention and control PCTs by cluster: 2009/10 to 2012/13

<p>The figure shows the change in this measure of quits over time for the intervention PCTs compared to their comparators in each of the six clusters. The clusters use the Office for National Statistics (ONS) subgroup categories for geographic areas of the UK based on similar local population characteristics. The eight intervention PCTs fall into six ONS subgroups along with 64 other PCTs which form the controls. Intervention PCTs are shown in black and control PCTs are shown in grey. 2009/10 = 0 and 2012/13 = 3.</p

The economic cost of measles:healthcare, public health and societal costs of the 2012-13 outbreak in Merseyside, UK

BACKGROUND: Measles is a highly contagious vaccine-preventable infection that caused large outbreaks in England in 2012 and 2013 in areas which failed to achieve herd protection levels (95%) consistently. We sought to quantify the economic costs associated with the 2012-13 Merseyside measles outbreak, relative to the cost of extending preventative vaccination to secure herd protection. METHODS: A costing model based on a critical literature review was developed. A workshop and interviews were held with key stakeholders in the Merseyside outbreak to understand the pathway of a measles case and then quantify healthcare activity and costs for the main NHS providers and public health team incurred during the initial four month period to May 2012. These data were used to model the total costs of the full outbreak to August 2013, comprising those to healthcare providers for patient treatment, public health and societal productivity losses. The modelled total cost of the full outbreak was compared to the cost of extending the preventative vaccination programme to achieve herd protection. FINDINGS: The Merseyside outbreak included 2458 reported cases. The estimated cost of the outbreak was £ 4.4m (sensitivity analysis £ 3.9 m to £ 5.2m) comprising 15% (£ 0.7 m) NHS patient treatment costs, 40% (£ 1.8m) public health costs and 44% (£ 2.0m) for societal productivity losses. In comparison, over the previous five years in Cheshire and Merseyside a further 11,793 MMR vaccinations would have been needed to achieve herd protection at an estimated cost of £ 182,909 (4% of the total cost of the measles outbreak). INTERPRETATION: Failure to consistently reach MMR uptake levels of 95% across all localities and sectors (achieve herd protection) risks comparatively higher economic costs associated with the containment (including healthcare costs) and implementation of effective public health management of outbreaks. FUNDING: Commissioned by the Cheshire and Merseyside Public Health England Centre

4-week quits per 1,000 adult population for intervention and control PCTs by cluster: 2009/10 to 2012/13

<p>The figure shows the change in quits over time for the intervention PCTs compared to their comparators in each of the six clusters. The clusters use the Office for National Statistics (ONS) subgroup categories for geographic areas of the UK based on similar local population characteristics. The eight intervention PCTs fall into six ONS subgroups along with 64 other PCTs which form the controls. Intervention PCTs are shown in black and control PCTs are shown in grey. 2009/10 = 0 and 2012/13 = 3.</p

intervention and control PCTs, changes between 2009/10 and 2012/13: model findings

<p>intervention and control PCTs, changes between 2009/10 and 2012/13: model findings</p

CO-validated 4-week quits as a percentage of the enrolled smokers for intervention and control PCTs by cluster: 2009/10 to 2012/13

<p>The figure shows the change in enrolment over time for the intervention PCTs compared to their comparators in each of the six clusters. The clusters use the Office for National Statistics (ONS) subgroup categories for geographic areas of the UK based on similar local population characteristics. The eight intervention PCTs fall into six ONS subgroups along with 64 other PCTs which form the controls. Intervention PCTs are shown in black and control PCTs are shown in grey. 2009/10 = 0 and 2012/13 = 3.</p

Intervention PCTs, ONS subgroups, clusters and number of control PCTs

<p>Intervention PCTs, ONS subgroups, clusters and number of control PCTs</p