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Original research article
Are valve clinics a sound investment for the health service? A cost-effectiveness model and an automated tool for cost estimation
  1. Adrian Ionescu1,
  2. Charlie McKenzie1 and
  3. John B Chambers2
  1. 1Morriston Regional Cardiac Centre, Swansea, Wales, UK
  2. 2Guy's and St Thomas’ Foundation Trust, London, UK
  1. Correspondence to Dr Adrian Ionescu; Adrian.Ionescu{at}wales.nhs.uk

Abstract

Background Valve disease is using up an important, growing proportion of the resources allocated for healthcare. Clinical care is often suboptimal and while multidisciplinary clinics are the ‘gold standard’, their adoption has been patchy and inhomogeneous.

Methods We hypothesised that adoption of valve clinics can deliver financial savings and set out to estimate differences in cost between a standard model in which the cardiologist sees every case and a multidisciplinary model in which some cases are devolved to sonographer-led or nurse-led clinics, assuming usage of various tests in accordance with practice at our institutions and to published data. We developed a tool that allows the modelling of limitless permutations in order to assess costs.

Results Seeing 100 new patients in a valve clinic is more expensive than seeing them in the conventional set-up (excess cost £2700, $4252). Follow-up of both patients with native valve disease (maximal savings/100 patients—£5166, $8135) and with operated valves (maximal savings/100 patients—£5090, $8015) is cheaper in a valve clinic than in a general cardiology clinic and the savings offset the increased cost of seeing new patients in the valve clinic.

Conclusions The costing implications of valve clinics need to be worked out carefully. Our analysis suggests that important savings in healthcare costs could be achieved by their adoption. Clarifying the economic implications of this new model of care should become one of the priorities for the ‘heart valve community’.

  • VALVULAR DISEASE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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