Biography:

Sarah Neville is the Director, Pricing at the Independent Hospital Pricing Authority (IHPA), and is responsible for delivering the National Efficient Price annually. Sarah’s background is in mathematics and statistics, holding a Ph.D. in statistics from the University of Wollongong. She was invited to present doctoral research at the University of Oxford in 2012. She recently spent six weeks in remote Australia working with Miwatj Health Aboriginal Corporation developing better ways to communicate key health statistics to Indigenous Australians.

Abstract:

In 2016 all Australian governments signed a Heads of Agreement that committed to improve Australians’ health outcomes and decrease avoidable demand for public hospital services through a series of reforms including the development and implementation of funding and pricing approaches for safety and quality.

Subsequently, the Independent Hospital Pricing Authority (IHPA) was directed to advise on options for a comprehensive and risk adjusted model to determine how funding and pricing could be used to improve patient outcomes across three key areas: sentinel events, hospital acquired complications (HACs) and avoidable hospital readmissions.

HACs are complications which occur during a hospital stay and for which clinical risk mitigation strategies may reduce the risk of their occurrence. Identification of most HACs is dependent upon the use of the Condition Onset Flag (COF). The COF is used to indicate whether a diagnosis was present on admission or hospital or occurred during an episode of care. HACs are defined using the criteria of preventability, patient impact (severity), health service impact and clinical priority. The list of HACs is available at https://www.safetyandquality.gov.au.

Currently, IHPA has recommended that all HACs across every hospital face a reduced funding level to reflect the extra cost of a hospital admission with a HAC, including an approach for risk adjustment based on a patient’s complexity. Under this option, the magnitude of the reduction would vary for each HAC.

This talk will focus on the construction and application of the risk adjustment model for the pricing and funding of HACs.

Biography:

Barbara Mascialino works at Health Economics and Outcome Research Manager at Thermo Fisher Scientific Immuno Diagnostics in Sweden. Barbara is a nuclear physicist with more than 15 years of experience in epidemiology, modelling and data analysis.

Abstract:

The majority of bowel disorders exhibit overlapping symptoms, making diagnosis difficult in primary care (PC). Inflammatory bowel diseases (IBDs) are characterized by chronic inflammation of the gastrointestinal tract; irritable bowel syndrome (IBS) is a functional disorder, with prevalence 10-20%. Endoscopy is the gold standard for detecting and quantifying IBDs, but due to its low prevalence (in Japan: 152x105 persons), it turns negative in most cases, it is expensive, uncomfortable and risky for the patient. F-Calprotectin is a fecal marker of intestine inflammation that can be used as a pre-endoscopic technique to rule out IBDs.

EliA Calprotectin 2 is expected to be launched into the Japanese market in 2017. The present study aims at evaluating the cost-effectiveness of a) EliA Calprotectin 2 test compared to the b) usage of serologic markers CRP and ESR, c) combined usage of these tests, and d) gold standard to distinguish IBD from IBS in Japan.

Methodology: A 18-weeks Markov model was developed for each diagnostic strategy, simulating 1000 patients presenting to PC with unspecific gastrointestinal symptoms. Outcomes include cost savings, cost per corrected IBD diagnosed, and colonoscopies reduction (including their complications). Uncertainty was addressed with sensitivity analysis.

Findings: Table 1 shows that EliA Calprotectin 2 is cost-effective compared to CRP+ESR, and to colonoscopy; it:

1) Results in more corrected IBD diagnoses at a lower price;

2) Reduces the number of unnecessary endoscopies, increasing the number of correctly diagnosed IBD (N=63) and IBS (N=26) patients.

Conclusion: Results show that the usage of EliA Calprotectin 2 as pre-endoscopic diagnostic tool is associated with less colonoscopies, and important cost savings ascribable to reduced resource utilization. F-Calprotectin is a dominant strategy in relation to the comparators; it should be recommended for reimbursement in Japan, and can be considered as good value for money for the health insurance system.