Pay for Quality

60 Pay for Quality KCE Reports 118
Table 1 : Cost-effectiveness evaluation of 12 QOF indicators by Mason et al.
(2008)
Quality indicator Incremental
QALYs per patient
AF3: treatment with anticoagulant
drug therapy or an antiplatelet
drug therapy
BP5: hypertension, BP 150/90 in
past 5 months
Incremental costs per Net monetary
patient treated (2006) benefit per patient
treated (2006)
treated (2006)*
1.465 to 2.2 -£1 162 to -£16 922 £45 162 to £46 222
0.7 £751 £13 249
CHD9: aspirin 0.0066 -£30 £162
CHD 10: beta blocker 1.89 £234 £37 566
CHD 11: ACE inhibitor/
Angiotensin Receptor Blocker
0.08 £488 £1 112
ChKD4: ACE inhibitor/
Angiotensin Receptor Blocker
0.8076 to 1.5308 -£31 811 to -£32 906 £49 058 to £62 427
CS1: Cervical screening 0.137 £68 £2 672
DM15: proteinuria /
microalbuminuria on ACE
0.7210 -£9 662 £24 081
DM21: diabetic retinal screening 0.4865 £9 750 -£21
LVD/HF3: ACE inhibitor/
Angiotensin Receptor Blocker
0.21 £25 £4175
Smoking 2: Smoking
advice/referral
0.0157 to 0.0451 £11 to £90 £303 to £812
Stroke9/stroke12:
antiplatelet/anticoagulant
0.17 £371 £3 029
* The net monetary benefit is calculated by assigning a value of £20,000 for each QALY gained.
Curtin et al. (2006) 225 focus on the cost-effectiveness of a pay for quality programme in
primary care in the USA, directed at physician organizations, and focusing specifically on
diabetic care. Between 2000 and 2004 a partnership was established between a Health
Plan and a physician organization. The physician organization withholds 10 percent of
claims payments to practitioners of which typically 70 percent to 100 percent is
available for distribution at the end of the year. Additional dollars derived from gainsharing
programmes were added to the pool. Payment in the Pay for Quality
programme varied from 50 to 150 percent, as a result from which an average full-time
primary care physician could earn between $6 000 and $18 000 extra in a given year,
based on performance. The return on investment calculation, included in this study
makes use of a cost trend, to project costs and compare the projected cost with the
actual cost. As a result the actual costs seem to be lower than the projected cost. As
shown in Table 2, this resulted in a plan saving of $1 894 470 in year 1 (2003) and
$2 923 760 in year 2 (2004). The annual system development costs were estimated at
$1 150 000. As a result the return on investment estimate would be 1.6 to 2.5.
Table 2 : Return on investment evaluation of a diabetes quality
improvement programme by Curtin et al. (2006)
Plan savings diabetes Total cost per year of Return on
care against two-year
rolling trend
the programme investment
Year 1 $1 894 470 $1 150 000 1.6:1
Year 2 $2 923 760 $1 150 000 2.5:1
Nahra et al. (2006) 107 evaluated the cost-effectiveness of hospital Pay for Quality
incentives in the USA, focusing on heart care related hospital inpatient care. The pay for
quality programme has been implemented in 85 hospitals and provides incentives to
increase adherence to heart-care related clinical guidelines. Three process measures for
heart care discharge have been considered, namely the percentage of eligible AMI
patients receiving aspirin orders at discharge, the percentage of eligible AMI patients