Is cost-minimisation analysis a scientifically acceptable method for deciding health sector intervention choices? : an observational case study of echocardiography

• Main Author: Cunningham-Davis, John Peter
• Published: University of Liverpool 2013
• Subjects: 338.473621
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.629946

Due to limited budgets and tight financial control of budget within the NHS, policy makers are faced with difficult decisions. Recent Governmental White Papers have turned the NHS full circle and it has returned to where it started in the 1990's. The primary care health sector is increasingly responsible not only for managing their own budgets but for providing services which need to be economically evaluated. In order to achieve this various goal, sources of evidence stemming from evidence based medicine, involving various evaluations are/paramount. Policy makers need to base their decisions on sources of evidence which have been subject to economic evaluation. This thesis attempts to illustrate where the best sources of evidence can.be obtained, either from Randomised Controlled Trials of Observational Studies when making choices involving cost-effective treatments and investigations and ensuring to appropriately use the relevant economic evaluation technique. Heart failure represents a major problem not only for society but also for the NHS. Many treatments have been developed for this condition and have been proven to be not only beneficial for the morbidity and mortality of patients but have also been shown to be cost-effective for the NHS. Their prescription however needs assessment via echocardiography. There are a large proportion of patients not receiving the optimal treatment and management. Such crucial issues make heart failure one of the best targets for a high yield, low health care intervention. Due to the advances of a primary care led NHS, the viability of a primary care service involving echocardiography was economically evaluated and compared via cost minimisation analysis, to a secondary echocardiography service. Results demonstrated not only the costs of patients to the NHS but also how echocardiography could assist in reducing this burden. Primary care echocardiography has also been demonstrated to be cost-effective compared with secondary care provision and recommendations for further research should consider the expansion of similar echocardiographic service encompassing a larger patient population in a multi health care centre. This would provide further evidence combined with the recent advances in technology for the necessary resources for funding such an expansion of schemes where the biggest impact will be achieved. Issues of equality of provision inherent with this expansion must also be addressed before any introduction.