1. Measuring Cost and Impact Nick Hex Project Director 28 March 2012

2. Understanding the economics – why is it important? Importance of cost effectiveness in decision-making; Changing commissioning landscape; Funding restrictions – QIPP; NHS Outcomes Framework.

3. Increasing survivorship

4. Economic costing February – October 2011: Models of the costs of different approaches to survivorship; Based on activity and costs at 4 pilot sites; Proxy costs and assumptions used.

5. Economic costing Key findings: The costs of LTFU care costs in secondary care have been reduced by risk stratification of patients New models of care increase capacity to provide care for more survivors; But good practice models of care may require additional costs.

6. Economic modelling

7. Objectives Our remit: Identify additional variables that will influence the cost of the new pathways and describe the effects of these; Produce a more detailed model of costs for a LTFU service; Develop the costing methodology into a model which can be easily used by commissioners and care providers to understand the costs of survivorship.

8. Additional cost factors Implementation and start-up costs; Quality improvements, eg, care coordinators, transition clinics etc; Services outside the acute sector.

9. Literature review Very little data or published studies; Costs, but no activity, for primary care; Services outside the acute sector do not have negative impacts on patient care.

10. Economic modelling: inputs Staffing activity Clinical staff NursesSupport Outpatient clinics Nurse-led clinics Telephone follow-ups Virtual review

11. Economic modelling: inputs Investigation costs; Quality additions; Additional primary care visits: GP time; Investigations. Tariff income.

12. Costing scenarios 1.Costs of treating 900 survivors with and without risk stratification; 2.The effect on the commissioning body and the hospital provider of changing service provision, ie. the impact of changing tariff income

13. Scenario 1: hospital costs Non risk-stratified service Numbers£ All patients900340,000 Risk-stratified service Numbers£ Level 17516,000 Level 2550178,000 Level 3275108,000 TOTAL302,000

14. Scenario 2: tariff impact Non-risk stratified serviceRisk-stratified service Hospital cost£340,000£302,000 Additional primary care cost -£32,000 Total£340,000£334,000 Tariff payment£315,000£228,000 Shortfall to provider£25,000£74,000

15. In summary Costing model indicates that hospitals may reduce costs through risk stratification but tariff income may also be reduced; Commissioners likely to incur additional primary care costs; More research needed around outcomes and the provision of services outside of secondary care;

16. Next steps Finalise model and issue for consultation, along with a user guide; Develop further scenarios; Draft report for NHS Improvement/NCSI.

17. Thank you Nick Hex nick.hex@york.ac.uk 01904 324830