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Pathway framework design and costing model(s) for Sexual Assault & Referral Centres (SARCs).

SARC services are currently undergoing a revision in funding arrangements between NHS and Police commissioning bodies.  Pathway Analytics conducted a costing review of SARC pathways in four different regions. We highlighted funding inconsistencies at a national and local level, as well as wide variations in service cost and delivery models making it difficult to identify and promote best practice. We proposed a new framework of client definition sets & developed a costing model that can be used throughout the service. 

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Our work on Chlamydia screening economics made an important contribution to the BMJ article: Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study.

Objectives To compare the cost, cost effectiveness, and sex equity of different intervention strategies within the English National Chlamydia Screening Programme. To develop a tool for calculating cost effectiveness of chlamydia control programmes at a local, national, or international level.

Design An economic and mathematical modelling study with cost effectiveness analysis. Costs were restricted to those of screening and partner notification from the perspective of the NHS and excluded patient costs, the costs of reinfection, and costs of complications arising from initial infection.

Main outcome measures Cost effectiveness of National Chlamydia Screening Programme in 2008–9 (as cost per individual tested, cost per positive diagnosis, total cost of screening, number screened, number infected, sex ratio of those tested and treated). Comparison of baseline programme with two different interventions—(i) increased coverage of primary screening in men and (ii) increased efficacy of partner notification.

Results In 2008–9 screening was estimated to cost about £46.3m in total and £506 per infection treated. Provision for partner notification within the screening programme cost between £9 and £27 per index case, excluding treatment and testing. The model results suggest that increasing male screening coverage from 8% (baseline value) to 24% (to match female coverage) would cost an extra £22.9m and increase the cost per infection treated to £528. In contrast, increasing partner notification efficacy from 0.4 (baseline value) to 0.8 partners per index case would cost an extra £3.3m and would reduce the cost per infection diagnosed to £449. Increasing screening coverage to 24% in men would cost over six times as much as increasing partner notification to 0.8 but only treat twice as many additional infections.

Conclusions In the English National Chlamydia Screening Programme increasing the effectiveness of partner notification is likely to cost less than increasing male coverage but also improve the ratio of women to men diagnosed. Further evaluation of the cost effectiveness of partner notification and screening is urgently needed. The spreadsheet tool developed in this study can be easily modified for use in other settings to evaluate chlamydia control programmes.

Source: BMJ 2011;342:c7250 

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Pathway Analytics has supported the London Sexual Health Programme in the development of a Tariff for Sexual Health Services throughout London. The Pathway Analytics team has taken the London Sexual Health Programme through the complete project life cycle, from scoping and early stage requirements, through building a supportive stakeholder community, to recommendation of an appropriate currency, tariff framework and pricing.

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Development of an economic framework to articulate the cost of care pathways in multiple settings for End of Life Care patients.

Commissioners required evidence that transfer of patients with End of Life Care (EoLC) needs to a community setting was cost neutral across the healthcare system for three London boroughs, while maintaining quality of care delivery.  Pathway Analytics worked with the Modernisation Initiative (MI) to develop an evidence-based As Is Economic Model which enabled commissioners to understand better the patient population across diagnosis spectrums in multiple settings vs. commissioning costs (top-down) and 'true' costs (bottom-up). This work provided a key input into the MI's strategic redesign recommendations and formed the basis for costing up future (To Be) delivery models.