This might sound daft but!!
I think the greatest number of QUALYS delivered to the NHS by health
care is the immunisation program! I actually believe the nurses
contribute more that way than any other program. Now if only we could
immunise against Heart disease, Cancer or maybe simple things like
dental caries that would would produce a far greater improvement.
When talking ratios like this it is more difficult to demonstrate a big
change for 95 % to 96% than from 20% to 80%. Introducing MMR and Hib
Immunisations cut out a huge number of hospital admissions rather like
Diphtheria immunisation in 1943.
I think a lot of the day to day prevention like this has become part
of the infrastructure of the NHS and has been controlled out of the
system.
Just to really challenge the list with an example
If you have short stature and this is diagnosed before puberty by a
paediatrician then you would be entitled to a regular prescription of
very expensive growth hormone injection. The cost of treatment maybe
£20,000 per year for 5 years. There are obvious values to the
individual concerned reaching the age of 21 upto 10 cm taller. They
are likely to have tracked from below the 3rd centile of the
population into the 10th centile for height.
My conundrum is this
Would the individual (or their family) be better with the money rather
than the growth hormone injections?
I hope this is a relevant contribution to the QUALY debate.
Philip
On Tuesday, March 27, 2007, at 10:45 am, John Appleby wrote:
> Good news, QALY fans, the answer (thanks to Alastair Fischer at NICE)
> to the question does not take NICE's £20k-£30k per QALY range, but
> uses the recent calculations by Pete Smith and colleagues at York of a
> cost per life year gained for cancer and circulatory diseasea (based
> on the DH national Programme Budget data (see
> http://www.york.ac.uk/inst/che/pdf/rp24.pdf.))
>
> Using this PCT spend data and variations in population health measures
> (mortaility), they suggest a cost per life year of around £13k for
> cancer spending and around £8k for circulatory disease spending. Total
> English NHS cancer spend in 2004/5 was around £3.7 bn, so LYs produced
> = 284,000. Circulatory spending was £6 bn, so LYs produced = 750,000.
>
> For the whole of the UK NHS spend in 2004/5 of £82.5 bn, assuming that
> cost per LY for all activities is somewhere between a pretty low
> number and a fairly high number - let's say, £13,000 on average....the
> NHS produces around 6.4 million LYs per year. And lastly, assuming
> that these LYs are not all of perfect quality (say, 0.9), then,
> quality adjusted life years produced by the UK NHS in one year will be
> of the order of...5.8 million (about 1.2 months per head of
> population).
>
> And in terms of what we got for the extra £7.8 bn spent on the UK NHS
> between 2003/4 and 2004/5, this suggests around 540,000 QALYs.
>
> So, the next question is: what proportion of this increase in QALYs
> could be attributable to improvements in the quality as opposed to the
> volume of health care?
>
> john
>
>
>
>
>
> John Appleby
> Chief Economist
> King's Fund
> 11-13 Cavendish Square
> London W1G 0AN
>
> Visiting Professor, City University
>
> T: 0207 307 2540
> M: 07831 638774
> F: 0207 307 2807
>
>
>
<image.tiff>
>
> From: This is a closed list of the UK Health Economists' Study Group
> (HESG) [mailto:[log in to unmask]] On Behalf Of Fordham Richard Dr
> (MED)
> Sent: 27 March 2007 08:22
> To: [log in to unmask]
> Subject: Re: QALYs produced by NHS
>
>
> Gentleman gentleman,
>
> If the NHS is spending £60bn of taxpayers money presumably in the
> cause of improving or saving lives then then assuming it does this
> 'efficiently' at the marginal rate of transformation of 30,000/QALY
> then it must be producing about 200,000 pa. Of course, 42 might be the
> actual answer..
>
> Regards,
>
> Ric
>
<image.tiff>
>
> From: This is a closed list of the UK Health Economists' Study Group
> (HESG) [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
> Sent: Tuesday, March 27, 2007 7:34 AM
> To: [log in to unmask]
> Subject: Re: QALYs produced by NHS
>
>
> You have all forgotten to divide it by 3.14........scandalous!
>
> Dr Tom Jefferson
> Via Adige 28a
> 00061 Anguillara Sabazia
> (Roma)
> Italy
>
> www.attentiallebufale.it
> Tel/Fax ++39 06 999 00 989
> Mobile ++39 32 92025051
> Email [log in to unmask]
>
>
> -----Original Message-----
> From: [log in to unmask]
> To: [log in to unmask]
> Sent: Mon, 26 Mar 2007 7.07PM
> Subject: Re: QALYs produced by NHS
>
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> Plus or minus?
>
> >>> Alan Maynard <[log in to unmask]> 03/26/07 5:12 PM >>>
> Forty two?
>
>
>
> On Mar 26 2007, John Appleby wrote:
>
> >Any even half-evidenced guess as to the total number of QALYs the NHS
> >produces each year?
> >
> >John Appleby
> >Chief Economist
> >King's Fund
> >11-13 Cavendish Square
> >London W1G 0AN
> >
> >Visiting Professor, City University
> >
> >T: 0207 307 2540
> >M: 07831 638774
> >F: 0207 307 2807
> >
> >
> >
>
>
Dr Philip Dawson
Dolphins Practice
Health centre
HAYWARDS HEATH
RH16 4BN
Tel 01444 414767
[log in to unmask]
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