Aim: To develop a cost effective and individualised service model for GH replacement therapy based on a joint decision making process with patients and commissioners.
Background: At University College London Hospital (UCLH), we have a caseload of about 300 adult patients treated with GH. Our in house structured GH treatment proforma is used at the patients initial consultation for joint decision making on prescribing the most suitable GH, e.g. non-refrigerated, needle free, dexterity and visual impairment. Choice of device is also based on clinical judgement (patients ability to handle the device) and cost-effectiveness. GH is prescribed and monitored by the Endocrine Team and reimbursed directly by CCGs; we send regular reports to GPs. Patients are registered with home service for device training, technical support and delivery of their GH and stores.
Outcomes and evaluation: Introduction of the home service in 2011 has provided a 20% cost saving on VAT which was previously applied on the drug dispensed by the Hospital Pharmacy. This also increased patient satisfaction through by reducing travelling time to collect GH. As GH products are PbR (payment by result) excluded they are charged in addition to the national tariff and ultimately funded by CCGs. The timeline from clinic consultation to treatment start has reduced to ~2 weeks compared to 4 months before we introduced in house tertiary prescribing and home service. When issuing a repeat prescription from UCLH, we ensure that up to date IGF1 and relevant other investigations are available for dose adjustment. This can be difficult to monitor when GH is prescribed in Primary Care. We regularly audit patients satisfaction with and adherence to GH treatment, quality of life, wellbeing and their satisfaction with the homecare service using validated and in house developed questionnaires and re-design our service based on feedback.
Conclusion: We found that a streamlined and structured pathway provides significant cost savings, shorter waiting times for treatment start, more accurate and safer monitoring while maintaining individualised care and patient satisfaction.