To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/add.12998 or contact your DHB library, or organisational or local library for assistance.

West, R., et al. (2015). Healthcare interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction, 29 May [Epub before print].

This interactive session will provide a range of tools and methods for capturing, understanding, improving through co-design and measuring patient and family experiences.

To find out more about this event, go to:  http://koawatea.co.nz/designing-for-transformational-patient-experience/

They conclude from the results that most emergency department patients "... with symptoms of possible ACS do not have a cardiac cause for their presentation. The current guideline-based process of assessment is lengthy, costly and consumes significant resources". They discuss the implications of these findings.

The article is available to read in free full text at:  http://dx.doi.org/10.5694/mja14.00472

Cullen, L., et al. (2015). Cost and outcomes of assessing patients with chest pain in an Australian emergency department. Medical Journal of Australia, 202(8), 427-432.

The Study of Heart and Renal Protection (SHARP) randomised trial prospectively collected information on kidney disease progression, serious adverse events and hospital care use in a cohort of patients with moderate-to-severe CKD. In a secondary analysis of SHARP data, the impact of participants’ CKD stage, non-fatal cardiovascular events and deaths on annual hospital costs (i.e. all hospital admissions, routine dialysis treatments and recorded outpatient/day-case attendances in United Kingdom 2011 prices) were estimated using linear regression.

7,246 SHARP patients (2,498 on dialysis at baseline) from Europe, North America, and Australasia contributed 28,261 years of data. CKD patients without diabetes or vascular disease incurred annual hospital care costs ranging from £403 (95% confidence interval: 345-462) in CKD stages 1-3B to £525 (449-602) in CKD stage 5 (not on dialysis). Patients in receipt of maintenance dialysis incurred annual hospital costs of £18,986 (18,620-19,352) in the year of initiation and £23,326 (23,231-23,421) annually thereafter. Patients with a functioning kidney transplant incurred £24,602 (24,027-25,178) in hospital care costs in the year of transplantation and £1,148 (978-1,318) annually thereafter. Non-fatal major vascular events increased annual costs in the year of the event by £6,133 (5,608-6,658) for patients on dialysis and by £4,350 (3,819-4,880) for patients not on dialysis, and were associated with increased costs, though to a lesser extent, in subsequent years.

The authors conclude that renal replacement therapy and major vascular events are the main contributors to the high hospital care costs in moderate-to-severe CKD. These estimates of hospital costs can be used to inform health policy in moderate-to-severe CKD.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12882-015-0054-0

Kent, S., et al. (2015). What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrology, 16:65.

Cost effectiveness analyses were undertaken alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence.

A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI −4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01).

The authors conclude that there is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. 

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0822-3

Brusco, N.K., et al. (2015). Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial. BMC Health Services Research, 15:165.

The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions. A systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making.

The authors found thirty-two examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the ‘real-world’ trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.

The authors conclude that health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.

This is an open access article and can be downloaded and read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0814-3

Cromwell, I., et al. (2015). ‘Real-world’ health care priority setting using explicit decision criteria: A systematic review of the literature. BMC Health Services Research, 15:164

The cost of treating cancer in the New Zealand public health sector is more than $800 million annually – hundreds of millions higher than previous estimates, according to University of Otago research.

Researchers from the University’s Department of Public Health, based in Wellington, have used a new method to calculate the total cost of treating cancer in the public sector, including costs by cancer type.

They calculated that the total cost of treating cancer in the public health system was $880 million, which is 26 percent greater than the Ministry of Health estimate (of $526 million) for the same period (based on data collected between 2010 and 2011).

According to the research, the cancers that the most public health dollars are being spent on annually are: colon (15%); breast (14%); and prostate, non-Hodgkin lymphoma and leukaemia (each at 6%).

The researchers found the cost varied greatly by cancer type. Melanoma is one of the cheapest cancers to treat at $8000 per diagnosed and treated case, whereas leukaemia, which costs on average $95,000 a case, is the most costly.

The lead author of the study, Professor Tony Blakely, says while the amount of money spent per cancer case was about the same for women and men, there was a noticeable difference in terms of how much was spent based on patient age.

“For example we spend more on 45-year-olds than we do on 85-year-olds. This suggests that the health system is working even harder to save younger lives through more actively pursuing such treatment options as surgery, chemotherapy and radiotherapy.”

Professor Blakely says he supported the introduction of more preventative measures that targeted known cancer causes.

“New Zealand has done a good job in many areas of cancer prevention by increasing tobacco control through taxes and law changes, and by increasing the tax on alcohol. The introduction of anti-cancer vaccines for human papilloma virus (HPV) and hepatitis B, and occupational health strategies such as banning asbestos imports, are other preventative measures that are helping in the reduce the cancer burden but much more could be done – especially in accelerating progress towards achieving the Government’s smokefree goal by 2025.”

Professor Blakely says there is a need for a national bowel cancer screening programme, especially since such programmes have proved to be cost-effective internationally and because colon cancer was the most costly cancer type overall.

Study co-author, Associate Professor Nick Wilson, from the University of Otago, Wellington, says it makes sense to introduce preventive measures that target New Zealand’s obesity epidemic because it would lower the cancer burden and help curb the country’s burgeoning healthcare bill.

“There are things that can be easily done by taking the food industry to task on food labelling, portion size and advertising junk food to kids. Then there is the issue of taxing unhealthy food. Without a doubt the Government should be following other countries and looking at a tax on sugary drinks as a start. It would not only save in terms of obesity and cancer costs but help in the fight against diabetes – a particularly expensive disease.”

PHARMAC is consulting on moving to the next stage in its hospital medical devices work – market share procurement. This next stage of activity would see PHARMAC offering suppliers an assured portion of the market in return for competitive pricing and quality products in appropriate cases.

“Today we are launching a discussion document so we can seek feedback from our colleagues in the health sector on our proposed approach to market share procurement,” says Director of Operations Sarah Fitt.

PHARMAC is proposing to use market share as a way to encourage competition and to achieve the best health outcomes for patients from hospital medical devices spending. District Health Boards (DHBs) spend up to $1 billion per annum on medical devices used in hospitals.

“We want to improve the value for money we get from spending on medical devices and ensure that we are providing national consistency in access to medical devices,” says Director of Operations Sarah Fitt.

The Discussion Document proposes that wound care would be the first category to be considered for market share procurement. PHARMAC has completed most of the national contracting activity in this area and now has enough information about the market and clinical advice to enable it to run a market share approach.

“The feedback we receive from the Discussion Document will help us to refine and develop a well thought-out market share procurement process,” says Sarah Fitt.

In 2012, Cabinet asked PHARMAC to work towards managing hospital medical devices, with the goal of managing expenditure in a more sustainable way, and providing better value for money.

The first national contracts for hospital medical devices took effect in February 2014. By 1 April 2015, PHARMAC had negotiated contracts for about 14,000 medical devices, covering approximately $44 million expenditure. The savings to DHBs from PHARMAC’s contracted medical devices (this financial year and last) are estimated at $11.9 million over five years.

The cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). 

In the retrospective cohort study (1131 patients), mean LoS was 5.46 days for type 1 diabetes, and 5.04 days for type 2 diabetes. Mean cost per admission was £1034. In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days versus 4.80 for unexposed patients. Exposed patients had a higher mortality risk compared with unexposed patients. Total average per-patient cost for exposed patients was GBP (£)2235, 40% higher than total average admission cost in unexposed patients.

The authors conclude that hypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1136/bmjdrc-2014-000057

McEwan, P., et al. (2015). Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: Retrospective record-linked cohort studies in England. BMJ Open Diabetes Research & Care, 3:e000057.

"Models described within the literature mainly focused on addressing issues at the input, throughput or output stages of ED care delivery. Models often varied to account for site specific characteristics (e.g. onsite inpatient units) or to suit staffing profiles (e.g. extended scope physiotherapist), ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Only a few studies conducted cost-effectiveness analysis of service models". The authors conclude that further research is needed to make accurate and reliable assessments of models' safety, clinical effectiveness and cost-effectiveness.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/1742-6723.12367 or contact your DHB library, or organisational or local library for assistance.

Wylie, K., Crilly, J., Toloo, G., FitzGerald, G., Burke, J., Williams, G. and Bell, A. (2015), Review article: Emergency department models of care in the context of care quality and cost: A systematic review. Emergency Medicine Australasia, 27(2), 95–101

PHARMAC is in active negotiations with several suppliers as a result of its competitive process for rare disorders medicines.

On the eve of World Rare Diseases Day, PHARMAC has announced that 28 proposals from eight suppliers emerged from its request for proposals, issued late last year.

Chief Executive Steffan Crausaz says from those proposals, PHARMAC has constructed a priority funding list and is currently in active negotiations with several suppliers.

“We were very pleased with the response from suppliers,” says Steffan Crausaz. “The whole idea of this process was that we could promote competition and produce lower prices than we had previously seen. This in turn would enable us to improve people’s access to these medicines, and lead to better health outcomes.”

“This was a very positive process with good buy-in from pharmaceutical companies. What we saw were proposals for medicines that we hadn’t seen before, suppliers who hadn’t been active in New Zealand before, and new proposals for products which had previously not been progressed for funding.”

Steffan Crausaz says PHARMAC identified that a lack of competition was as a barrier to better access to medicines for rare disorders. PHARMAC identified up to $5 million per year for the next five years that could be available for funding a rare disorders contestable pilot, and sought proposals from suppliers in August 2014.

Steffan Crausaz says working through the list of products PHARMAC wants to fund from the rare disorders process is expected to take several months. Each medicine funding proposal will be subject to public consultation.  First decisions are likely to be made in mid-2015.

PHARMAC will evaluate the process once it is completed before deciding whether to run the process again. 

Data included 21 stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, a staff survey (n=55) and staff pedometer data (n=56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital. 

(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move.

(2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection.

(3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.

The authors discuss the implications of these findings.

This is an open access report that is available to read in free full text at:  http://www.journalslibrary.nihr.ac.uk/hsdr/volume-3/issue-3#hometab0

Maben J, Griffiths P, Penfold C, Simon M, Pizzo E, Anderson J, et al. (2015). Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation. Health Services and Delivery Research, 3(3).

Lean is an organizational redesign approach focused on elimination of waste, which is defined as any activity that consumes resources (e.g., staff, time, money, space) without adding value to those being served by the process.

In addition to background information and the results of a literature review, the report presents six case studies from five organizations that implemented Lean principles in different types of health care settings. Recommendations are provided for similar organizations wishing to implement Lean in their facilities.

http://www.ahrq.gov/professionals/systems/system/systemdesign/leancasestudies/index.html

"Stakeholder groups disagreed as to what constitutes effective and inclusive patient involvement. Barriers reported by interviewees included poor communication, a lack of transparency, unworkable deadlines, and inadequate representativeness. Also described were problems associated with defining the task for patients and their advocates and with the timing of patient input in the decision-making process". Interviewees made suggestions for improving patient participation. The authors discuss the implicaiton of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/hex.12356 or contact your DHB library, or organisational or local library for assistance.

Lopes, E., Street, J., Carter, D. and Merlin, T. (2015), Involving patients in health technology funding decisions: Stakeholder perspectives on processes used in Australia. Health Expectations, 21 February [Epub before print]

Twenty-nine studies were included. "Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities)".

The authors conclude that "... policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs".

Now available to read in free full text at: http://dx.doi.org/10.1016/j.hjdsi.2014.09.002 

Trenaman, L., et al. (2014). The cost-effectiveness of patient decision aids: A systematic review. Healthcare, 2(4), 251–257.

Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations.

In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.

To read the report in full text, go to: http://www.commonwealthfund.org/publications/fund-reports/2015/jan/international-profiles-2014

A new United States study finds that smokers and the obese ring up substantially higher annual health care costs than their nonsmoking, non-obese peers. The added costs are highest among women, non-Hispanic whites and older adults, the study reports.

"Health care costs associated with obesity and smoking are substantial, about $1,360 and $1,046 per person per year, respectively," said University of Illinois kinesiology and community health professor Ruopeng An, who conducted the analysis. These numbers reflect the added costs of obesity and smoking above the average annual health care expenditures of non-obese and nonsmoking Americans, he said.

To read the full news article, go to: http://www.medicalnewstoday.com/releases/287705.php

Thirteen randomised controlled trials were included., involving involving 9615 participants with dementia. 

Based on the results of their analysis, the authors conclude that "there is some evidence that case management is beneficial at improving some outcomes at certain time points, both in the person with dementia and in their carer. However, there was considerable heterogeneity between the interventions, outcomes measured and time points across the 13 included RCTs. There was some evidence from good-quality studies to suggest that admissions to care homes and overall healthcare costs are reduced in the medium term; however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes". They discuss the implications of these findings.

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD008345.pub2

Reilly S, Miranda-Castillo C, Malouf R, Hoe J, Toot S, Challis D, Orrell M. (2015). Case management approaches to home support for people with dementia. Cochrane Database of Systematic Reviews, 1, CD008345.

Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years’ vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection.

Interventions:  No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years.

The authors found that giving at least two doses of vaccine seemed to be "... highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years’ protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17 000, interquartile range £11 700-£25 800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom".

The authors conclude that two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely monitored.

This is an open access article and is available to read in free full text at:  http://www.bmj.com/content/350/bmj.g7584

Jit, M., et al. (2015). Comparison of two dose and three dose human papillomavirus vaccine schedules: Cost effectiveness analysis based on transmission model. BMJ, 350:g7584.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/1355819614562053 or contact your DHB library, or organisational or local library for assistance.

Birch, S., et al. (2015). In place of fear: Aligning health care planning with system objectives to achieve financial sustainability. Journal of Health Services, Research and Policy, 20(2),  109-114.

South Island DHBs have saved over $4million through initiatives in facilities and maintenance. By working collaboratively through the South Island Alliance's Support Services group, DHBs' facilities and maintenance teams have implemented new technologies and taken advantage of bulk buying contracts to reduce facilities and maintenance costs by $4.32 million.

Initiatives for savings included things like installing new more efficient boilers and light bulbs, renegotiating electricity contracts and collectively using one architectural and drafting contract for building works.

Chair of the Support Services group that undertook the work and Southern DHB Building and Property Manager Warren Taylor said the ability to share ideas was key to the successful cost reductions. "By being able to work alongside counterparts around the South Island we could each clearly see areas where we could find efficiencies and work together to negotiate contracts."

"To save over $4million was a huge achievement and that money can now be reinvested in patient care and in further building and facilities initiatives. We always have to make careful decisions about how we prioritise maintenance and facilities upgrades, but by working together through the Alliance, we have been able to work more efficiently and stretch the health dollar further than before."

Case Study: Nelson Marlborough DHB shift to energy efficient lights
One idea that has come into fruition has been Nelson Hospitals replacement of fluorescent lights with energy efficient LED lights. This is a huge job, with around 3600 lights needing to be replaced. However, the time and cost involved in the upgrading the old lights are well worth it when balanced against the benefits:

• Using low energy LED lights will reduce the hospital's energy consumption by 10 percent
• Lighting quality is better for staff and patients
• LED lights are non-toxic, meaning less dangerous waste going into landfills
• LED lights also emit less heat, meaning a reduction in the level of air conditioning required

By being able to share ideas and develop best practise through the Alliance, South Island DHBs have been able to implement a whole range of initiatives like this one in Nelson Hospital that are improving efficiency in facilities and maintenance.

A new agreement for a high cost biologic drug will yield considerable savings for DHBs over the next five years, says PHARMAC.

Infliximab is a monoclonal antibody, one of the so-called `targeted drugs’ used to treat auto-immune conditions like rheumatoid arthritis, inflammatory bowel diseases, and psoriasis. It is a high cost drug used in hospitals, with current spending in the region of $15 million per year and growing rapidly.

Director of Operations, Sarah Fitt says PHARMAC saw an opportunity to reduce the price of infliximab following expiration of the patent and subsequent launch of biosimilar brands overseas, and the likelihood these would become available in New Zealand. PHARMAC called for proposals from suppliers of infliximab, including suppliers of infliximab biosimilars.

“Biosimilars become available once biologic drugs come off-patent, go through a robust safety and efficacy assessment by regulators like Medsafe, and provide significant opportunities for PHARMAC to reduce costs, widen access, and release funding for reinvestment by DHBs,” says Sarah Fitt.

Sarah Fitt says the decision continues PHARMAC’s work in managing the rising costs of biologic medicines – those made of, or from, living organisms – through competition from biosimilars. Biosimilars are competitor products to biologic medicines.

PHARMAC was able to secure a 30% reduction on the list price currently paid by DHBs plus additional savings through confidential rebates arrangements with the supplier.

“The competition from biosimilars provided an opportunity for us to significantly reduce DHBs’ spending on infliximab,” says Sarah Fitt.

“We have secured, through an agreement with Janssen, continued supply of the incumbent brand – Remicade – at a significantly lower cost that will yield savings of more than $25 million over the next five years. While savings will be made, there will be no impact on prescribers  or patients who will stay on their current brand.”

“This is the first time we have run a competitive process for a monoclonal antibody medicine, and we are very pleased with the outcome.”

The price reduction on infliximab comes into effect from 1 January 2015.

Eight years ago Waikato District Health Board (DHB) paid more than $523,000 a year to advertise for staff. In the last financial year that figure had reduced by 82 per cent to $93,130, acting general manager Human Resources Greg Peploe told the board at its monthly meeting yesterday (26 November).

“The DHB continues to push for savings,” he said.

“Already this financial year the DHB comparable spend for recruitment advertising has reduced by a further $18,807.”

Of significance last month was the appointment of a general medicine physician to a role which had been advertised for nearly a year.

“The successful candidate is New Zealand trained, returning from working in the UK, to commence in February 2015.”

Waikato DHB does very little print advertising now “because it is not effective anymore.”

Instead it relies on its own website www.waikatodhb.health.nz/jobs where it sources 60 per cent of its successful candidates.

Four per cent come from Kiwihealthjobs which is New Zealand’s largest dedicated health job board owned by the 20 district health boards and NZ Blood Service.

Launched in 2011, it now regularly receives more than 40,000 visitors each month.

Recently it launched an advertising pilot for non-district health board organisations.

What started out as a relatively small site,has now become a leading brand for health sector opportunities.

“Six per cent of (our) successful candidates find out about the job through a friend or word of mouth,” said Mr Peploe.

“This is an important source for harder to reach candidates.”

All Waikato DHB positions are advertised on its website and feature on the DHB’s Facebook and Twitter feeds.

PHARMAC will change the way it makes funding decisions from late next year. Its nine Decision Criteria will be replaced by 15 Factors for Consideration.

The change will occur in late 2015 once PHARMAC is certain that people understand the new Factors and how they will be used. The changes follow an extensive public consultation process during 2013 and 2014.

Chief Executive Steffan Crausaz says the Factors, like the current Decision Criteria, will help PHARMAC when making funding decisions.

“They will help us continue to meet our legislative objective, which is to achieve the best health outcomes for people that are reasonably achievable from within the funding provided.

“We sought the views of the community, health professionals, pharmaceutical suppliers and public during this process. This was important as the way we make decisions affects nearly every New Zealander.

“Feedback through consultation helped us to understand what people want us to be thinking about in our decision-making. It also told us what we can improve in our current processes to help people understand how we make our decisions.”

“One of the major changes is the explicit acknowledgement that PHARMAC considers the impact of a decision on a person, their family, whānau and on wider society, and also recognises the wider impact on the health system.  PHARMAC will consider these impacts in terms of need, health benefits, costs and savings, and suitability.

“PHARMAC also acknowledges its commitment as a partner of Te Tiriti o Waitangi by considering the impact of a decision on Māori health need,” says Steffan Crausaz.

Other population groups facing inherent health disparity will also be considered under PHARMAC’s new framework.

“Pacific peoples and other population groups experiencing health disparity will be specifically considered, and PHARMAC will endeavour to engage further with the Pacific community to identify how we can work towards improving PHARMAC’s responsiveness.”

Steffan Crausaz says PHARMAC is announcing the change now to give people sufficient advance notice of the coming change.

“The changes are substantive. This lengthy lead-in time will enable PHARMAC to help familiarise people with the new Factors to make sure they are well understood before they come into effect. This will help to ensure a smooth transition to the new decision making framework.

“We are aware that there is significant work that needs to be undertaken before the changes can be implemented. We are working through these and will keep people informed throughout this process.”

PHARMAC reviewed its Decision Criteria as part of a wider look at its operating policies and procedures. Changes are designed to support the range of PHARMAC’s funding decisions, including medicines, vaccines and medical devices.

PHARMAC has produced supporting information that provides more detail on each of the Factors for Consideration and how PHARMAC will use these in its decision-making.  

This year's Quality Accounts focuses on the following 10 areas:

In this chartbook, the author uses data collected by the Organization for Economic Cooperation and Development (OECD) and other agencies to compare health care systems and performance on a range of topics, including spending, hospitals, physicians, pharmaceuticals, prevention, mortality, quality and safety, and prices.

It concludes by highlighting four lessons that CCGs, other commissioners and providers should keep in mind as they embark on new models of commissioning and contracting to support integrated care".

The report is available to download and read in free full text at:  http://www.kingsfund.org.uk/publications/commissioning-contracting-integrated-care

Addicott, R. (2014). Commissioning and contracting for integrated care. London: King's Fund.

The report authors suggest that savings of nearly £2 billion can be made through better clinical practice, for example in the use of tests and medicines.

Among the report’s recommendations is a call for greater use of NICE’s ‘do not do’ database, which it describes as an “excellent resource” for doctors who want to question the value of particular clinical practices.

NICE’s ‘do not do’ database contains all the recommendations that NICE has made for clinical practices that should either be discontinued or not used routinely within the NHS.

To download the report, go to:  http://www.aomrc.org.uk/doc_download/9793-protecting-resources-promoting-value.html

To read a NICE news article about the report, go to:  https://www.nice.org.uk/news/article/cut-nhs-waste-through-nice%E2%80%99s-%E2%80%98do-not-do%E2%80%99-database

Health Minister Jonathan Coleman says the Government has agreed to explore a proposal put forward by DHBs to move implementation of the shared services programme to a DHB-owned vehicle.

“While Health Benefits Limited (HBL) has made good progress in developing savings plans for DHBs, the responsibility for implementing these business cases needs to sit with DHBs,” says Dr Coleman.

“Now is the right time to consider the organisational options for DHBs to lead the implementation phase of the business cases on finance and procurement, laundry, national IT infrastructure, and food services.

“It is important to maintain momentum on implementing these business cases to ensure savings are freed up from the back office and re-invested into frontline health services.

“The DHBs preference is for healthAlliance (FPSC) Limited to lead the implementation process.

“I have asked the Acting Director-General of Health to establish an interim project governance group to work through the next steps which will include a due diligence process. A final proposal will then be taken to Cabinet for approval.

“It is expected that HBL will be wound down once the appropriate transitional plans have been agreed. This handover is expected to occur by the end of June 2015.”

Associate Health Minister Peter Dunne heads for Washington DC today to attend the Commonwealth Fund’s 17th International Symposium on Health Care Policy.

“A major theme of the 2014 symposium is how different health systems meet the challenge of delivering care for patients with high needs and high costs,” says Mr Dunne.

Along with a number of other health ministers from Europe and North America, Mr Dunne will participate in panels and policy roundtable events.

“The Symposium provides an excellent opportunity to showcase the innovations in policy and practice that this Government has put in place to ensure the excellence and financial stability of the New Zealand public health system.

“It’s an opportunity to discuss evidence on improving health system performance, reflect on practical lessons that might be valuable for New Zealand, and talk frankly with Ministers and senior officials about initiatives that improve patients' experience of health care.

“We often share common problems but frequently differ in our solutions.  

“This meeting is a useful opportunity to hear at first-hand about other countries’ experiences and what they’ve learned”, Mr Dunne said.

Health Minister Jonathan Coleman says the Government is considering options for moving to the implementation stage of the DHB shared services programme.

“Health Benefits Limited (HBL) has made good progress in developing savings plans for DHBs,” says Dr Coleman.

“These programmes will result in substantial savings being freed up from the back office and re-invested into frontline health services such as more operations, and better cancer treatment.”

The business cases on finance and procurement, laundry, national IT infrastructure, and food services have been developed.

“These cases now have to be implemented, and it is important to get this process right,” says Dr Coleman.

“The Government needs certainty on the investment costs and savings projections, and the path ahead. 

“DHBs need to be highly engaged around investment decisions and the Government is seeking their views on the best way to implement the business cases.”

HBL and DHBs have achieved over $300 million in savings since HBL was established in July 2010. DHBs are for example saving around $4 million a year after signing up to a collective banking arrangement.

Drawing on analysis of the latest data on GP services and the results of a separate survey of over 100 influential health and social care leaders, the Nuffield Trust argues that general practice is in need of both more money and significant reform to enable it to meet the challenges set out by NHS England in its recent Five Year Forward View. 

The Nuffield Trust’s report ‘Is General Practice in Crisis?’ describes how the number of one-doctor GP practices has halved in seven years, from 1,717 in 2006 to 891 in 2013, whilst the number of practices with ten or more doctors has grown by over 75%. The separate survey of health and social care leaders finds that over three-quarters (77%) of respondents agree that small GP practices are no longer fit for purpose.

The briefing also shows that reported funding for general practice has fallen by almost £300m in a single year, between 2012/13 and 2013/14. The authors argue that general practices will need extra resources and support to link up with each other and find new ways to meet the different needs of their patients. 

Working in bigger, better-organised groups can carry the important neighbourhood presence that many GP surgeries have through tough times. But it will need politicians to give GPs time and support as they make the switch to scaled-up general practice fit for the future.Mark Dayan, Policy Officer, Nuffield Trust

 The Nuffield Trust report finds that:

• There is evidence of a looming staffing crunch in general practice, with over half of doctors over the age of 50 saying they’ll quit direct patient care in the next five years, a rise of over a third since 2010.
• At the same time, more than 1 in 10 slots of new GP trainees were left unfilled this year and there are increasing numbers of GPs working part-time.
• In the last financial year alone (2013/14), spending on GP services fell by 3.8% or £287m, according to the most recent Department of Health annual report and accounts. 
• The briefing notes a ‘worrying’ lack of basic information on numbers of GP consultations, which make it impossible to determine the extra pressures facing GPs However, the report recognises that an ageing population with complex needs is putting general practice under strain.

The survey of health and social care leaders, the second of four being conducted in the run-up to the election, shows that:

• Leaders overwhelmingly recognise the need to move away from the traditional family doctor model: a third of respondents said that general practice is in crisis, and two-thirds said it is in need of reform 
• While over half of respondents support more funding, many of them said it should not come without changes to the way general practice operates. 

Nigel Edwards, Chief Executive of the Nuffield Trust said:

“There is no doubt that general practice is facing great pressures at the moment. Funding is tight, there is an impending workforce crisis and - perhaps most significantly of all - the needs of patients have changed beyond recognition, as the population lives longer with chronic conditions. As our panel of health and social care leaders recognise, the single-doctor practice is now struggling to deal with these challenges and is looking increasingly inviable. But more money alone isn’t the answer.”  

The briefing paper outlines the need for GPs to evolve their practices into ‘super GP practices’ – networks of multiple practices that can pool resources and draw in specialist expertise from other professionals like pharmacists, geriatricians and psychiatrists, while also retaining the benefits of the ‘small and local’ model of the past. The principle of realising the benefits of larger size is backed by 9 in 10 of the Nuffield Trust’s health and social care leaders, who agree that GP practices need to be part of larger groups or federations to meet the needs of the population over the next five years and beyond. 

In the words of one panel member:

“The 1930s model of corner shop general practice is no longer fit for purpose. It needs to become much more responsive to its customers’ expectations about access and fully integrated with a community, voluntary and social care team, to provide a complete package of joined-up care”. 

Mark Dayan, lead author and Nuffield Trust Policy Officer said: 

“Many GPs are already joining up to build successful networks with other healthcare professionals in their area. This doesn’t mean that the familiarity of local practices will be lost or that GPs will vanish from rural areas. Working in bigger, better-organised groups can carry the important neighbourhood presence that many GP surgeries have through tough times. But it will need politicians to give GPs time and support as they make the switch to scaled-up general practice fit for the future.” 

The Nuffield Trust briefing sets out four key recommendations for politicians seeking to reform general practice:

• Avoid the temptation to adopt a ‘one size fits all’ model or top down targets: local contracts and incentive schemes led by commissioners should encourage solutions that work for different areas;
• Use the GP contract to encourage practices to join together with other GPs and professionals such as hospital specialists, pharmacists and social care staff;
• Improve the availability of data on patient demand for general practice, which the Nuffield Trust says is inadequate;
• Increase investment for a period of ‘double running’ for a fixed period of time in the next parliament to help GPs design and implement new models of care.

The analysis comes soon after NHS England unveiled its Five Year Forward View, setting out a rethink of the way the NHS operates to meet the needs of a rapidly changing population. According to the Forward View, GPs will need to operate at scale and upskill significantly in the future.

DHBs are expected to start making further savings in cardiac medical devices, after PHARMAC extended the range of products it already has under national contracts by beginning listing those used in cardiac procedures.

The 303 items now listed on the Pharmaceutical Schedule are the first in what is expected to be a large number of interventional cardiology medical devices available at national prices.

The agreement with Bio-Excel includes equipment such as stents and balloons and offers DHBs initial savings of about $150,000 from current national expenditure of about $1.2 million.

Following discussions with the Cardiac Society and a Registration of Interest process earlier this year, PHARMAC sought proposals from suppliers, and this is the first agreement reached with a supplier in the interventional cardiology category.     

Director of Operations, Sarah Fitt, says PHARMAC’s contracting in the medical device area is increasing quickly and highlights its drive to create value for DHBs.

“We’ve already put in place nine other national agreements across the categories of wound care, sutures and laparoscopic equipment, and this move into interventional cardiology devices means we are now able to offer DHBs over $2 million in savings if they take up these opportunities,” Sarah Fitt says.

“We’ve now got over 5000 medical devices under contract covering national expenditure of about $35 million and our activity in this space is increasing all the time. We’re looking to expand the number of contracts available in the current categories, while also seeking agreements with suppliers in other areas, such as devices used in trauma surgery.”

PHARMAC is currently consulting on a proposal to list a further 630 interventional cardiology devices supplied by Medtronic, offering potential savings of another $200,000 to DHBs.

PHARMAC is aiming to get nationally consistent lower prices, and reduce future pricing pressures, on items that many DHBs are already using.

Participants discussed approaches that have been successful in reducing LoS and have subsequently improved flow through hospitals without having a detrimental impact on the wider health and social care system or patient outcomes/experience.

A series of case studies outlining successful approaches to reducing length of stay were presented during the event:

• Good Hope Hospital, Heart of England Foundation Trust
• Healthcare at Home
• Northumbria Healthcare Foundation Trust
• Poole Hospital NHS Foundation Trust
• Sheffield Teaching Hospitals NHS Foundation Trust
• Wrightington, Wigan and Leigh NHS Foundation Trust

To view the case studies, and for further information, go to: http://www.nuffieldtrust.org.uk/talks/reducing-hospital-length-stay

"Analysis at a population level suggests if 10,000 individuals receive 12 weeks of specialist evidence-based care, the cost savings are likely to be A$9,238,800. Significant savings could be made by the adoption of evidence-based care such as that provided by the community and outpatient specialist wound clinics in this study".

To read the full abstract, and for information on how to access the full text, go to: http://search.informit.com.au/documentSummary;dn=668374495637499;res=IELHEA or contact your DHB library, or organisational or local library for assistance.

Graves, N; Finlayson, K; Gibb, M; O'Reilly, M and Edwards, H. (2014). Modelling the economic benefits of gold standard care for chronic wounds in a community setting. Wound Practice & Research: Journal of the Australian Wound Management Association, 22(3), 163-168.

Twenty-seven studies from 14 different healthcare systems were included. "In the included studies, total annual costs for dementia of up to $70,911 per patient (mixed setting) were estimated (average estimate of total costs = $30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are informal costs due to home based long term care and nursing home expenditures rather than direct medical costs (inpatient and outpatient services, medication)".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1002/gps.4198 or contact your DHB library, or organisational or local library for assistance.

Schaller S., Mauskopf J., Kriza C., Wahlster P. and Kolominsky-Rabas P. L. (2015). The main cost drivers in dementia: A systematic review, International Journal of Geriatric Psychiatry, 30(2), 111–129.

Following a 4-week pilot period, a mobile drop-in SSS was delivered across various public locations in Nottingham City, UK for 6 months, offering behavioural and pharmacological support via one-to-one consultations with trained cessation advisors. Detailed demographic and smoking behaviour data were collected from all clients accessing the mobile SSS, and Nottingham's standard SSS for comparison.

Compared with smokers accessing the standard SSS (n=1856), mobile SSS smokers (n=811) were significantly more likely to be from the RM group (33.3% vs 27.2%), and to be first-time SSS users (67.8% vs 59.3%). Nearly 1 in 10 smokers setting a quit date through the mobile SSS had no prior quit intentions. The cost per smoker setting a quit date for the mobile SSS was only slightly higher than the standard SSS (£224 vs £202).

The authors conclude that a mobile drop-in SSS is an effective way of reaching more disadvantaged smokers from RM occupations, as well as those who have not previously accessed standard SSS and those without prior quit intentions.

This is an open access article and can be read in free full text at: http://dx.doi.org/10.1136/tobaccocontrol-2014-051760

Venn, A., et al. (2014). Effectiveness of a mobile, drop-in stop smoking service in reaching and supporting disadvantaged UK smokers to quit. Tobacco Control, 26 September [Epub before print]

"Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1097/MLR.0000000000000248 or contact your DHB library, or organisational or local library for assistance.

Martsolf, G.R., et al. (2014). Examining the value of inpatient nurse staffing: An assessment of quality and patient care costs. Medical Care, 52(11), 982-988.

The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided.'

The authors discuss these findings.

This is an open access article and is available to read in free full text at: http://dx.doi.org/10.1186/1472-6963-14-478

Wiig, S., et al. (2014). Talking about quality: exploring how 'quality' is conceptualized in European hospitals and healthcare systems. BMC Health Services Research, 14, 478.

These potential benefits and savings are even larger when the expected growth in the numbers of people diagnosed with cancer over the next 15 years is taken in to account.

The Incisive Health report, commissioned by Cancer Research UK, also estimates that if the best national levels of early diagnosis were delivered across the country, an extra 5,000 cancer patients would be alive five years after diagnosis. This would potentially go a long way towards achieving the Government’s cancer survival goals and bridge the survival gap with other countries.

The report estimates that, without action to reduce late diagnosis, treatment costs for the four cancers will soar by approximately £165 million over the next decade, as the number of cancer cases rises due to an ageing population.

Sara Hiom, director of early diagnosis at Cancer Research UK, said: “Diagnosing cancer at its earliest stages is crucial to give patients the best chance of survival. There are a number of reasons why cancer may be diagnosed at an advanced stage. For some cancers, such as pancreatic, symptoms are often only noticeable once the tumour has already started to spread. But for many others there are chances for the cancer to be picked up earlier.

To read the full media release from Cancer UK, go to: http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2014-09-22-half-of-cancers-diagnosed-at-late-stage-as-report-shows-early-diagnosis-saves-lives-and-could-save

To download the full report by Incisive Health, go to: http://www.incisivehealth.com/uploads/Saving%20lives%20averting%20costs.pdf

Incisive Health (2014). Saving lives, averting costs: An analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer. [London]: Incisive Health / Cancer Research UK.

HIIRC identified this research via the Ministry of Health Library's Grey Matter newsletter.

Over 1200 US hospitals are currently participating in Keystone ICU. This paper examines the cost changes and cost-effectiveness of the Keystone ICU project from the perspective of the hospital, using a decision tree model to address the choice faced at an individual hospital about implementing the programme) and nationally representative data sources.

The authors found that, this programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections.

This is an open access article and can be read in full text at: http://dx.doi.org/10.1136/bmjopen-2014-006065

Herzer, K.R., et al. (2014). Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA. BMJ Open, 4, e006065.

Value in Health is the official journal of the International Society for Pharmacoeconomics and Outcomes Research.

The scan aimed to provide evidence on austerity and health care from a wider international perspective, focusing in particular on the following four questions:

1. What policy responses have health systems internationally taken in response to the financial crisis?
2. How effective have these measures been in achieving cost savings and efficiencies?
3. What impact have these measures had – desired or unintended – on the quality of care?
4. What can the UK NHS learn from experiences and evidence from elsewhere?

The project took a case study approach, gathering and analysing evidence for the following six countries: Canada, Denmark, Ireland, the Netherlands, Portugal and Spain.

To download and read the evidence scan in full text, go to: http://www.health.org.uk/publications/international-responses-to-austerity/

Ellins, J., et al. (2014). International responses to austerity. London: Health Foundation.

The authors describe mixed results, and discuss the implications for future projects.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1377/hlthaff.2014.0419 or contact your DHB library, or organisational or local library for assistance.

Busse, R., et al. (2014). Integrated care experiences and outcomes in Germany, The Netherlands, and England. Health Affairs, 33(9), 1549-1558

Knee and/or hip joint replacement surgical patients are hugely benefiting from receiving Tranexamic Acid injections before surgery at Palmerston North Hospital.

Patients are getting mobilised sooner, are spending less time in hospital, don’t need blood transfusions, and are showing reduced signs of swelling after leaving hospital, thanks to orthopaedic surgeons giving them the injections.

An initial trial of 15 knee or hip joint replacement surgery patients were given the injections to see if it would reduce blood loss, the need for blood transfusions, and the need for blood drains.

The trial by orthopaedic surgeons at Palmerston North Hospital has gone better than expected with huge benefits for patients, with reduced costs another unexpected but welcome benefit.

Surgeons wanted to know if the injections had:

• Reduced the need for blood transfusions
• Have patients mobilised earlier because of it
• Has it reduced the length of stay for patients
• Has it reduced cost with not having to administer blood transfusions, and
• Has it reduced cost with not using blood drains

Results have shown the average time it took a patient to mobilise has reduced from 22.83 hours to 18.7 hours.

The average length of stay for a patient has reduced from 3.7 days to 3.5 days.

Also there has been a noticeable reduction in swelling and bruising 10 to 14 days after surgery, especially for knee replacement patients.

All up the project has also produced an unexpected saving of about $200-$300 per patient not having blood transfusions, and blood drains, and only needing one to two tranexamic acid injections a patient depending on which procedure they have.

They found that administrative costs account for 25 percent of total U.S. hospital spending. These were the highest costs across the nations studied. Scotland and Canada had the lowest administrative costs.

The authors make recommendations for reducing U.S. per capita spending for hospital administration.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1377/hlthaff.2013.1327 or contact your DHB library, or organisational or local library for assistance.

To read more about the study, go to:  http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs

Himmelstein, D.U., et al. (2014). A comparison of hospital administrative costs in eight nations: US costs exceed all others by far. Health Affairs, 33(9), 1586-1594.

A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care.

The cost per additional quality-adjusted life year (QALY) gained was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY.

The authors note that, while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. They conclude that second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.

This is an open access article and can be read in full text at:  http://dx.doi.org/10.1093/ageing/afu067

Henderson, C., et al. (2014). Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial. Age and Ageing, 43(6), 794-800.

The Health Foundation has launched a new Efficiency Research Programme, which will make £800,000 available for research to look at ways to improve efficiency and value for money in health and social care. The programme comes at a time when the Health Foundation has increased its capacity and interest in economics, with the recruitment of Anita Charlesworth to the post of Chief Economist earlier on this year.

Researchers can submit research proposals to explore new approaches to support transformational change in health and health and social care in the UK. There are four key priority areas for this programme:

• allocative efficiency: achieving a more cost-effective mix of services within health and social care to maximise the health of the UK.
• aligning incentives: generating the greatest pull to improve efficiency and value for money.
• technology and workforce: optimising the role of technology and the workforce to improve efficiency.
• diffusion of best practice: optimising the spread and diffusion of efficient practice in health and social care services.

The funding opportunity is likely to be of interest to research teams in health economics, business and management, and operational research to explore some of the most powerful ways that health and social care services can address the challenge of increasing value and providing more for less. Proposals for projects can be for between £250,000 and £500,000, and the research should be completed within five years.

Professor Nick Barber, Director of Research at the Health Foundation, comments: 'Our aim for this programme is to support innovative projects; ones that generate new knowledge to help the health and social care system become sustainable in the longer-term. We look forward to receiving research ideas in under researched areas such as primary care, community and mental health, as well as research that takes a patient pathway or local health economy perspective. In time the outputs from the programme should provide powerful lessons and examples about how to improve efficiency and value for money in health and social care services in the UK.'

Visit www.health.org.uk/efficiencyresearch to find out more.

For every one person that is killed by smoking every year, 20 are living with a smoking-related illness, and nearly a million now require support with basic tasks".

To read the full article in The Independent (UK), go to: http://www.independent.co.uk/life-style/health-and-families/health-news/smoking-costs-england-1bn-per-year-in-care-alone-9706845.html

In this prospective observational study, the authors investigated the effects of displaying reference laboratory costs and turn-around times during computerised physician order entry (CPOE) on inpatient physician ordering behaviour at a tertiary care hospital.

After the intervention, the mean number of monthly physician orders per inpatient day at risk decreased by 26% with a decrease in mean cost per order. The authors conclude that "display of reference laboratory cost and turn-around time data during real-time ordering may result in significant decreases in ordering of reference laboratory tests with subsequent cost savings".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1136/bmjqs-2014-003053 or contact your DHB library, or organisational or local library for assistance.

Fang, D.Z., et al. (2014). Cost and turn-around time display decreases inpatient ordering of reference laboratory tests: A time series. BMJ Quality & Safety, 23(12), 994-1000.

Reducing the cost of subsidised co-payments appears to have led to an increase in the number of children under 6 using after-hours accident and medical clinics, according to a government-commissioned report released today.

The report, written by lead researcher Dr Tim Tenbensel from the University of Auckland, evaluates initiatives designed to reduce barriers to accessing after-hours and urgent medical care in the Auckland region. These initiatives, sponsored by the Greater Auckland Integrated Health Network, include the Accident and Medical (A&M) intervention, which introduced subsidised co-payments and increased opening hours to 11 participating A&M clinics across Auckland.

This research was funded by the Health Research Council of New Zealand in partnership with the Ministry of Health. It was commissioned under the government’s Better, Sooner, More Convenient Primary Health Care initiative, which aims to deliver a more personalised primary health care system that provides services closer to home and makes Kiwis healthier.

For those patients that were eligible for subsidised co-payments*, the report’s researchers estimated that use of the participating A&M clinics was 13 per cent higher than expected (8600 patients) over the course of the initiative’s second year (September 2012 – August 2013). The number of patients aged over 65 using A&M clinics was higher than predicted (although still low); however, the biggest indication of a positive effect was for children under 6 years.

“We are confident that increases in the use of accident and medical clinics, particularly for under-6s, can be attributed to the A&M intervention. This is based on economic analysis of the data, which shows that reducing co-payments to zero had a strong influence on the use of A&M clinics by under-6s in low income neighbourhoods,” says Dr Tenbensel.

These results corresponded with an estimated 10 per cent (7000 patients) drop in the number of eligible patients presenting to hospital emergency departments. However, Dr Tenbensel stresses that this decrease cannot necessarily be attributed to the A&M intervention because of other confounding factors.

The report also evaluated two other initiatives: an after-hours telephone triage service offered by HomeCare Medical Limited (HML), where patients can call their GP after hours, and the St John Transport (SJT) Initiative, which aims to reduce the number of patients St John Ambulance services transports to emergency departments who can be safely managed in the community.

Awareness of the HML service was found to be low, with only 10 per cent of surveyed patients aware that their family doctor provided an after-hours telephone service.

Over the first 24 months of the SJT Initiative (December 2011 to November 2013), 2967 patients were diverted by ambulance to an Auckland A&M clinic. In 88 per cent of these transfers, patients were successfully managed in primary care, while 10 per cent were referred on to hospital.

The report concluded that the SJT Initiative had made a “small difference” to patients’ use of A&M clinics and hospital emergency departments. Surveys of ambulance patients showed that those who were transferred to A&M clinics were satisfied with their care as long as they were seen by a doctor or nurse on arrival.

Dr Tenbensel says while it is too early to expect these initiatives to show positive results, the report does indicate the key issues to address if these services are to play a positive role.

“The value in all the initiatives lies more in the processes by which they came about – as a consequence of constructive engagement between Auckland region health organisations – and less in the capacity of these instruments to quickly solve endemic, structural health system problems,” says Dr Tenbensel.

• To download a copy of the full report, go to https://cdn.auckland.ac.nz/assets/fmhs/reports/BSMC-HRC-12-940-FINAL-REPORT-16-May-2014.pdf

* Patients eligible for subsidised co-payments include children aged under 6; patients aged 65 and over; holders of High User Health Cards; holders of Community Service Cards; and residents of deprivation 9 and 10 areas according to the Census (2006).

New Zealanders’ use of generic medicines is likely to grow further following the just-completed 2013/14 PHARMAC tender. The tender reached record levels this year, receiving nearly 3500 offers to supply pharmaceuticals from 54 companies.

PHARMAC has now awarded 246 contracts from this tender process, likely to produce savings of approximately $38 million (across hospital and community medicines) over three years.

“The savings from the tender are important for PHARMAC and serve two purposes,” says PHARMAC’s Director of Operations Sarah Fitt. “Firstly we need to make savings to enable us to fund the growing volume of medicine that is used in New Zealand each year.”

“And secondly, it can free up funding that we can then use to invest in new medicines. This enables us to produce greater health gains for New Zealanders, which is what PHARMAC is all about.”

New Zealand already has one of the highest usage rates of generic medicines in the world, according to the OECD Health at a Glance report. The report shows 73% of all medicines used in New Zealand are generics. Only Germany and the UK have higher rates of generics use.

Sarah Fitt says this comparatively high usage in New Zealand is largely because of the annual PHARMAC tender, which actively seeks bids for medicines coming off-patent and promotes competition between suppliers.

“New Zealanders are now familiar with generic medicines, and are used to changing between brands of medicine from time to time,” says Sarah Fitt. “This can happen as a result of our tender, and PHARMAC supports change through information for patients, pharmacists and prescribers. This has also helped with acceptance of generics.”

Sarah Fitt says people also have greater understanding that generic medicines go through the same quality, safety and efficacy checks as any other medicine before being registered by Medsafe.

PHARMAC also actively manages all supply contracts  to ensure New Zealand continues to enjoy fewer stock shortages than other countries.

Significant decisions from the current tender include new contracts for different presentations of the painkiller paracetamol, New Zealand’s most-prescribed medicine, which is estimated to result in saving more than $2 million  over three years.

Moving to sole supply of the mental health medicines, quetiapine and olanzapine will produce the biggest savings from the current tender so far. The quetiapine decision – moving to the Quetapel brand – is likely to save more than $6 million over three years. And sole supply for olanzapine adds a further $2 million of savings. 

Other products awarded tenders that will produce savings of $1 million or more over three years include the painkiller tramadol, the cancer treatment paclitaxel, and the migraine medicine rizatriptan.

DHBs will save another $650,000 a year from lower priced wound care and surgery equipment through a new national PHARMAC agreement with a major medical device supplier.

From 1 September, DHBs can use a national contract to buy products from Covidien New Zealand Limited including wound dressings, casting bandages, medical tapes, surgical stitches (sutures) and items used in abdominal keyhole surgery.

The agreement follows others PHARMAC has reached with eight other suppliers of medical devices such as wound care, sutures and disposable laparoscopic equipment. Since February this year PHARMAC has listed almost 5000 individual medical device products on the Pharmaceutical Schedule.

So far, PHARMAC has achieved minimum national annual savings of almost $2 million for DHBs through its medical device procurement activity since the first listing earlier this year.

The new contract with Covidien covers products that account for DHB spending of about $4.6 million per year, with savings of over 14 percent.

Previously DHBs had to individually negotiate their own prices for these products and potentially ended up paying different prices for the same products.

PHARMAC is aiming to get nationally consistent lower prices, and reduce future pricing pressures, on items that many DHBs and primary care providers are already using.

Director of Operations Sarah Fitt says the deal is significant.

“Covidien is one of a number of major suppliers to DHBs and this agreement means all DHBs can get this equipment for the same price. Equal access across the country and transparent pricing is a key reason why PHARMAC is doing this work, but we also need to get savings for DHBs at the same time,” Sarah Fitt says.

“The contracts are also protection for DHBs against rising prices.”

“PHARMAC is now looking toward reaching agreements with suppliers of interventional cardiology equipment and orthopaedic implants and will be expanding into other categories of products over time.”

This national contracting activity is the first step towards PHARMAC assuming broader responsibility for hospital medical devices on behalf of DHBs– in the same way it manages new technology assessment, contracting and expenditure on hospital and community medicines, and vaccines.

Details about PHARMAC’s medical device activity and its work towards management, can be found on its website: www.pharmac.health.nz/medicines/hospital-devices/

A Prescribing for Diabetes report from the Health and Social Care Information Centre (HSCIC) shows the Net Ingredient Cost (NIC) for managing diabetes was £803.1 million in 2013-14. This is a 5.1 per cent increase from £764.1 million in 2012-13 (£2.1 million per day on average) and a 56.3 per cent increase on £513.9 million in 2005-06 (£1.4 million per day on average).

Almost 10 per cent (9.5 per cent) of the total primary care drugs bill was spent on managing diabetes and this shows a continuous annual rise from 6.6 per cent in 2005-06.

This report provides the latest trends for diabetes medicines prescribed in primary care in England in the period April 2005 to March 2014.

The report shows that in primary care in 2013-14:

• There were 45.1 million prescription items4 for managing diabetes, an average of 123,610 items per day. This is a rise of 6.1 per cent on last year (42.5 million, or 116,510 items per day on average) and 66.5 per cent rise on 2005-06 (a rise of 18.0 million or 49,370 items per day on average).
• Insulin items can be prescribed for both type 1 and type 2 diabetes and accounted for about one in seven (14.3 per cent or 6.5 million items) items prescribed for diabetes which is similar to 2012-13 (14.6 per cent or 6.2 million) and slightly lower than in 2005-06 (17.4 per cent or 4.7 million).
• Seven out of ten diabetes prescription items were for antidiabetic drugs which are prescribed only for type 2 diabetes (70.3 per cent or 31.7 million items). This is a 6.9 per cent increase on 29.7 million items in 2012-13, and almost double the figure in 2005-06 (16.1 million items).
• Diagnositic and monitoring devices made up the remainder of diabetes items prescribed and the majority of these were blood glucose testing strips.
• Costs of all three categories of diabetes drugs have increased from 2005-06 but in particular insulin items where the rise in spending was 11.6 per cent higher than the rise in items prescribed.

HSCIC Chair Kingsley Manning said: "Today's report brings to light the rising costs for managing diabetes in primary care.

"Diabetes continues to be one of the most prevalent life-threatening conditions in England and now accounts for almost 10 per cent of the drugs bill. Our latest data highlights the growing implications to the NHS and patients of managing this condition."

You can find the full report at http://www.hscic.gov.uk/pubs/presdiab0514

They conclude that "continued increases in the incidence of diagnosed diabetes combined with declining mortality have led to an acceleration of lifetime risk and more years spent with diabetes, but fewer years lost to the disease for the average individual with diabetes. These findings mean that there will be a continued need for health services and extensive costs to manage the disease, and emphasise the need for effective interventions to reduce incidence".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/S2213-8587(14)70161-5 or contact your DHB library, or organisational or local library for assistance.

Gregg, E.W., et al. (2014). Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985—2011: A modelling study. The Lancet Diabetes & Endocrinology, 2(11), 867 - 874

To read the document, go to: http://asthmafoundation.org.nz/wp-content/uploads/2012/04/2014-Asthma-Information.pdf

Based on the results of their analysis, the authors conclude that "new services generated a more complex system where new and existing providers delivered overlapping services. The new provision did not induce substitution and was likely to have increased overall demand. Initiatives to improve access to existing provision may have greater potential to improve access and convenience at lower marginal costs".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.healthpol.2014.07.011 or contact your DHB library, or organisational or local library for assistance.

Tan, S. & Mays, N. (2014). Impact of initiatives to improve access to, and choice of, primary and urgent care in the England: A systematic review. Health Policy, 118(3), 304–315.

The author also notes that "many small studies reported high satisfaction rates of these models among patients and health professionals including Indigenous populations. One single center study reports that it is safe to supervise chemotherapy delivery remotely and many studies report cost savings to the health systems". The author goes on to say that "future teleoncology models would need to include web-based models, mobile technologies and remote chemotherapy supervision models".

Available to read in full text at: http://onlinelibrary.wiley.com/doi/10.1111/ajco.12225/full

Sabesan, S. (2014), Medical models of teleoncology: Current status and future directions. Asia-Pacific Journal of Clinical Oncology, 10(3), 200-204.

HPV vaccination of New Zealand school boys is not yet a value-for-money option, according to a study just published by the University of Otago, Wellington.

Until the vaccine price drops and various other cost-saving strategies are also adopted – such as using just two doses rather than the current three doses of vaccine – the Government should focus on increasing HPV vaccination uptake in girls at schools, the authors say.

One of the study’s authors, Associate Professor Nick Wilson, says New Zealand has “some way to go” to catch up to the coverage levels of over 80% of school girls seen in some other countries such as the UK.

One way to achieve this could be to follow these other countries by continuing to allow free vaccination in the school setting for 12-year-old girls, but not funding other out-of-school options which parents sometimes don’t follow up on, Wilson says.

HPV vaccination is showing benefits around the world in terms of markedly dropping rates of genital warts and some types of pre-cancer, which can proceed on to cervical cancer. The vaccination is also very likely to prevent a range of other genital cancers and head and neck cancer in both women and men.

The University of Otago, Wellington study found that the current programme for girls was good value for money, but adding vaccination for boys would cost a lot more per amount of health gained - vaccination of boys at the level of coverage as currently achieved for girls would cost $117,500 per quality-adjusted life-year (QALY) gained.

“This is clearly not cost-effective when using a typical threshold of the GDP-per-capita of New Zealand to gain an extra year of healthy life, which is around $45,000,” Wilson says.

“If New Zealand invested in vaccinating boys, there would be the likely opportunity cost of not funding interventions that achieve more health gain or, more bluntly, not getting the biggest ‘bang for our buck’ elsewhere in the health sector.”

Wilson suggests New Zealand would perhaps be better off investing in other vaccinations such as the meningococcal C vaccination used in a campaign in Northland recently.
However, the price of the HPV vaccine is almost certain to drop in the future, especially as PHARMAC has now taken over the role of price negotiating from the Ministry of Health, Wilson says.

PHARMAC can now negotiate vaccine prices at the same time as contracts for other products from the same pharmaceutical manufacturers.

The study found that a lower vaccine price would improve the cost-effectiveness of vaccinating boys. However, the combined vaccine and administration costs had to be under $125 per dose of vaccine delivered, before vaccinating boys became cost-effective at the GDP-per-capita threshold.

“Vaccinations are usually great value for money – but we are not at this point with giving the HPV vaccination for boys,” Wilson says.

The Australian Government is now providing fully subsidised HPV vaccination to school boys – in large part because this government seems to have struck a particularly good deal with the vaccine manufacturer, Wilson says.

“But national pride might also have played a part – since the HPV vaccine was first invented in Australia.”

The study is published in the international peer-reviewed journal BMC Infectious Diseases, and the study team was predominantly funded by the Health Research Council.

The Plan focuses in particular on projected demand growth for radiation therapy, its implications for linear accelerator (‘linac’) and workforce capacity, and associated cost impacts. It also considers issues arising from this capacity modelling, including:

• variation in access to radiation therapy
• radiation therapy intervention rates
• development of national benchmarking and standards to support performance and quality improvement
• evaluation and uptake of new techniques and models of care
• fostering national collaboration.

To download and read the Plan, go to:  http://www.health.govt.nz/publication/radiation-oncology-national-linear-accelerator-and-workforce-plan

Health Partners Consulting Group (2014). Radiation Oncology National Linear Accelerator and Workforce Plan. Wellington: Ministry of Health.

The authors used the Nationwide Inpatient Sample and Census Bureau data to quantify population-based incidence and associated cost for SA-SSTI hospitalizations.

SA-SSTI associated hospitalizations increased 123% from 160,811 to 358,212 between 2001 and 2009, and they represented an increasing share of SA- hospitalizations (39% to 51%). SA-SSTI incidence (per 100,000 people) doubled from 57 in 2001 to 117 in 2009 (p < 0.01). A significant increase was observed in all age groups. Adults aged 75+ years and children 0-17 years experienced the lowest (27%) and highest (305%) incidence increase, respectively. However, the oldest age group still had the highest SA-SSTI hospitalization incidence across all study years. Total annual cost of SA-SSTI hospitalizations also increased and peaked in 2008 at $4.84 billion, a 44% increase from 2001. In 2009, the average associated cost of a SA-SSTI hospitalization was $11,622 (SE = $200).

The authors conclude that there has been an increase in the incidence and associated cost of SA-SSTI hospitalizations in U.S.A. between 2001 and 2009, with the highest incidence increase seen in children 0-17 years. However, the greatest burden was still seen in the population over 75 years. By 2009, SSTI diagnoses were present in about half of all SA-hospitalizations.

This is an open access article and is available to download and read in free full text at:  http://www.biomedcentral.com/1471-2334/14/296/abstract

Suaya, J.A., et al. (2014). Incidence and cost of hospitalizations associated with Staphylococcus aureus skin and soft tissue infections in the United States from 2001 through 2009. BMC Infectious Diseases, 14:296.

Six relevant economic evaluations were assessed (3 from North America and 3 studies from Europe). "All studies reported the use of home monitoring devices that measured and transmitted different physical indicators to nurses who provided personalised feedback to patients during weekdays. The six studies involved a total of 559 COPD patients of whom 281 were randomised to telehealth. The review demonstrated a potential for cost savings ... However, the quality of the economic evidence was poor ....[and] caution is advised for healthcare decision-makers seeking large-scale implementation of telehealth in routine clinical practice".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/1357633X14533896 or contact your DHB library, or organisational or local library for assistance.

Udsen, F.W., et al. (2014). A systematic review of the cost and cost-effectiveness of telehealth for patients suffering from chronic obstructive pulmonary disease. Journal of Telemedicine and Telecare, 20(4), 212-220.