Calculating Total Health Service Utilisation and C

Authors: Caroline Canavan Joe West Timothy Card

Publish Date: 2015/10/26

Volume: 34, Issue: 2, Pages: 181-194

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Abstract

Health economic models are increasingly important in funding decisions but most are based on data which may therefore not represent the general population We sought to establish the potential of realworld data available within the Clinical Practice Research Datalink CPRD and linked Hospital Episode Statistics HES to determine comprehensive healthcare utilisation and costs as input variables for economic modellingA cohort of patients with irritable bowel syndrome IBS who first saw a gastroenterologist in 2008 or 2009 and with 3 years of data before and after their appointment was created in the CPRD Primary care outpatient inpatient prescription and colonoscopy data were extracted from the linked CPRD and HES The appropriate cost to the NHS was attached to each event Total and stratified annual healthcare utilisation rates and costs were calculated before and after the gastroenterology appointment with distribution parameters Absolute differences were calculated with 95  confidence intervalsTotal annual healthcare costs over 3 years increase by £935 95  CI £928–941 following a gastroenterology appointment for IBS We derived utilisation and cost data with parameter distributions stratified by demographics and time Women older patients smokers and patients with greater comorbidity utilised more healthcare resources which generated higher costsThese linked datasets provide comprehensive primary and secondary care data for large numbers of patients which allows stratification of outcomes It is possible to derive input parameters appropriate for economic models and their distributions directly from the population of interestAccurate costs from the health service perspective can be precisely attached to the Clinical Practice Research Datalink CPRD and linked Hospital Episode Statistics HES data at an individual level and these data can be used to calculate accurate total healthcare utilisation rates and costsHealth economic evaluations are becoming increasingly important in the decisions made regarding healthcare provision and policy In many healthcare settings funding for a service drug or intervention is dependent on demonstrating its cost effectiveness These evaluations require complete and detailed longitudinal data for large numbers of patients regarding the course of their health conditions the consequences and the costs 1 Historically this has been difficult to retrieve or compile The increase in electronic collection of routine healthcare data means realworld data are becoming more available Realworld evidence from electronic health records represents actual clinical practice and patient heterogeneity in a way not often reflected within randomised controlled trials RCTs 2 3 The large number of patients available for study provides the opportunity for subgroup stratification and assessment of rare diseases and outcomes which is usually not possible with RCT data An additional benefit is the many years of data available for each patient 2

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