Pay for Quality

KCE Reports 118 Pay for Quality 59
• Concerning depression/mental illness primary care indicators, osteoarthritis
care indicators. Chronic child care indicators, epilepsy indicators and chronic
kidney disease, a very limited amount of articles were found, with an effect
ranging from an absence of effect to a positive effect.
Generic findings
• With regard to chronic disease management there is a positive relationship
with several targets and an absent or positive relationship with not
incentivized targets.
• On the overall QOF achievement there is a positive effect. Several QOF
targets showed a decrease in variability after implementation of P4Q
• There effects with regard to CMP use are mixed.
• Regarding patient and provider satisfaction the effect ranged between no
effect and a positive effect. Concerning variability a very small decrease was
found after implementing P4Q.
4.4 REPORTED COST EFFECTIVENESS AND MODELLING
EFFECTS OF P4Q PROGRAMMES
4.4.1 Cost-effectiveness of Pay for Quality
Few reports have been identified concerning cost-effectiveness evaluations of Pay for
Quality programmes. Only three studies focus on cost-effectiveness of pay for quality
programmes, one in the UK 224 and two in the USA 107 , 225 .
Mason et al. (2008) 224 focus on the cost-effectiveness of the Quality Outcome
Framework implemented in primary care and addressed at general practices. Twelve
clinical QOF indicators have been considered that have a direct therapeutic impact (see
Table 1). These included preventive, acute and chronic care targets concerning
hypertension, heart diseases, heart failure, stroke, diabetes, kidney disease, cervical
screening and smoking cessation. The QOF payments are based on point achievement,
adjusted for practice size and disease prevalence relative to national average values. The
annual per patient payment that is paid by the government, ranged from £0.13 to £87.79
in 2004-2005 and from £0.22 to £73.04 in 2006-2007. For the economic evaluation of
this programme a threshold of £20 000 per QALY was assumed. According to this
analysis, the most cost-effective indicators are the use of ACE inhibitors or Angiotensin
Receptor Blocking (ARB) for chronic kidney disease, anticoagulant therapy for atrial
fibrillation, and beta blockers for coronary heart disease. Note that the costeffectiveness
varies strongly by baseline uptake. In general, one can state that, when
baseline implementation rates are high, larger absolute changes in utilisation are
required for indicators to be cost-effective. High baseline utilisation rates imply that
many patients already receive the treatment, hence general practitioners receive
payments for patients already being treated in a correct way. In 2006, only one indicator
was not cost-effective, namely diabetic retinal screening.