Miaoqing Yang1, Annette Bishop2, Jon Sussex3, Martin Roland4, Sue Jowett5, Edward C F Wilson6. 1. RAND Europe, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK. Electronic address: miaoqing.yang@npeu.ox.ac.uk. 2. Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, UK. Electronic address: a.bishop@keele.ac.uk. 3. RAND Europe, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK. Electronic address: Jon_Sussex@rand.org. 4. Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SR, UK. Electronic address: mr108@cam.ac.uk. 5. Research Institute for Primary Care and Health Sciences, Keele University, Keele ST5 5BG, UK; Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: s.jowett@bham.ac.uk. 6. Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SR, UK; Health Economics Group, University of East Anglia, Norwich, NR4 7TJ, UK. Electronic address: ed.wilson@uea.ac.uk.
Abstract
OBJECTIVES: Our aim was to undertake an economic evaluation of patient direct access to physiotherapy in the UK NHS by comparing the number of patients treated, waiting time, cost and health gain from a direct access pathway versus traditional GP-referral to NHS physiotherapy. DESIGN: The authors used a discrete event simulation (DES) model to represent a hypothetical GP practice of 10,000 patients. Costs were measured from the perspective of the NHS and society. Outcomes were predicted waiting times, the total number of patients with musculoskeletal conditions who received physiotherapy and quality adjusted life years (QALYs) gained, each estimated over a one year period. Model inputs were based on a pilot cluster randomised controlled trial (RCT) conducted in four general practices in Cheshire, UK, and other sources from the literature. RESULTS: Direct access could increase the number of patients receiving at least one physiotherapy appointment by 63%, but without investment in extra physiotherapist capacity would increase waiting time dramatically. The increase in activity is associated with a cost of £4999 per QALY gained. CONCLUSIONS: Direct access to physiotherapy services would be cost-effective and benefit patients given current cost per QALY thresholds used in England. This is because physiotherapy itself is cost-effective, rather than through savings in GP time. Direct access without an increase in supply of physiotherapists would increase waiting times and would be unlikely to be cost saving for the NHS owing to the likely increase in the use of physiotherapy services. Crown
RCT Entities:
OBJECTIVES: Our aim was to undertake an economic evaluation of patient direct access to physiotherapy in the UK NHS by comparing the number of patients treated, waiting time, cost and health gain from a direct access pathway versus traditional GP-referral to NHS physiotherapy. DESIGN: The authors used a discrete event simulation (DES) model to represent a hypothetical GP practice of 10,000 patients. Costs were measured from the perspective of the NHS and society. Outcomes were predicted waiting times, the total number of patients with musculoskeletal conditions who received physiotherapy and quality adjusted life years (QALYs) gained, each estimated over a one year period. Model inputs were based on a pilot cluster randomised controlled trial (RCT) conducted in four general practices in Cheshire, UK, and other sources from the literature. RESULTS: Direct access could increase the number of patients receiving at least one physiotherapy appointment by 63%, but without investment in extra physiotherapist capacity would increase waiting time dramatically. The increase in activity is associated with a cost of £4999 per QALY gained. CONCLUSIONS: Direct access to physiotherapy services would be cost-effective and benefit patients given current cost per QALY thresholds used in England. This is because physiotherapy itself is cost-effective, rather than through savings in GP time. Direct access without an increase in supply of physiotherapists would increase waiting times and would be unlikely to be cost saving for the NHS owing to the likely increase in the use of physiotherapy services. Crown
Authors: Filippo Maselli; Leonardo Piano; Simone Cecchetto; Lorenzo Storari; Giacomo Rossettini; Firas Mourad Journal: Int J Environ Res Public Health Date: 2022-01-04 Impact factor: 3.390