Pay for Quality

KCE Reports 118 Pay for Quality 65
Key points on reported cost effectiveness and modelling effects of P4Q
programmes
Cost effectiveness
• One study in the UK and two in the USA focus on cost-effectiveness of P4Q
programmes.
• From the twelve QOF-indicators, investigated in the UK study, only one,
diabetes retinal screening seemed to be not cost-effective.
• The USA study focussing on P4Q programmes in primary care (diabetic
care) showed a positive return on investment ranging between 1.6 and 2.5
per invested US dollar.
• The third study evaluated the cost-effectiveness of hospital P4Q
programmes focussing on heart care. Applying a $50 000 per QALY
threshold, the programme seems to be cost-effective even in a worst case
scenario.
Modelling costs
• Three UK studies, and two USA studies predicted short term financial
consequences or long term health consequences of P4Q programmes.
• Concerning the long term financial consequences, one USA study has
investigated two P4Q programmes. One programme is break-even, it
collects money in a pool of funds that is used to pay bonuses afterwards. The
other programme redistributes almost $10 million more than it collects.
• Another US programme estimated the potential decrease in payments due
to the reduction of post-admission complications in hospital care. The
implementation of such a P4Q programme could result in a payment
reduction to hospitals between 0% and 3.29%. The overall reduction equals
to 1.01% of hospital payments, with corresponds with a reduction in
payments of $1.005 billion.
• One UK study explored the link between financial incentives and likely
population health gain within the QOF system. As a result there seems to be
no obvious relationship between payment and health gain for these 8
interventions.
• Finally two UK studies estimated the health gain if a number of QOF quality
measures were to be met. The first study uses the baseline activity as
comparator, the second study uses no activity as comparator. In the first
study reaching the cholesterol target and the targets concerning
hypertension management were the most effective in preventing CHD
events in cardiovascular patients. In the second study, influenza
immunization and primary prevention for hypertension carry the greatest
potential for lives saved, although is must be noted that influenza
immunization already reaches high achievements. Hence, taking the
baseline activities into account, the results of this study are an
overestimation of potential life gain.