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Requisite models for strategic commissioning: the example of type 1 diabetes

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Abstract

A developing emphasis of health care reforms has been creating organisations with responsibilities for strategic commissioning of services for defined populations. Such organisations must set priorities in aiming to meet their populations’ needs subject to a budget constraint. This requires estimates of the health benefits and costs of different interventions for their populations. This paper outlines a framework that does this and shows how this requires modelling to produce estimates in a way that is transparent to commissioners, of requisite complexity to produce sound estimates for priority setting using routinely available data. The example illustrated in this paper is an intervention that would improve glucose control in the English population with type 1 diabetes. It takes many years for a change in glucose management to deliver maximum benefits; hence the intervention is not good value-for-money in the short run. We aim to give a more strategic view of the costs and benefits modelling costs and benefits in a steady-state model which suggests that the intervention is good value-for-money in the long run.

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Acknowledgments

The authors wish to thank Christina Georgiou for testing the model with several PCTs, four anonymous referees, and acknowledge the financial support of the Health Foundation.

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Authors and Affiliations

  1. Operational Research Group, Department of Management, LSE, Houghton street, London, WC2A 2AE, UK

    Mara Airoldi

  2. Operational Research Group, Department of Management, LSE, London, UK

    Gwyn Bevan & Alec Morton

  3. Centre of Management Studies, Instituto Superior Técnico, Technical University of Lisbon, Lisbon, Portugal

    Mónica Oliveira

  4. Isle of Wight NHS Primary Care Trust, Isle of Wight, UK

    Jenifer Smith

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  1. Mara Airoldi
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  2. Gwyn Bevan
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  3. Alec Morton
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  4. Mónica Oliveira
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  5. Jenifer Smith
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Corresponding author

Correspondence to Mara Airoldi.

Appendix

Appendix

1.1 Model parameters

Table 12 Parameters shared by the renal and eye disease model: mortality rate of the non-diabetic population and incidence rate of diabetes
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Table 13 Incidence rates of sores/ulcers and amputation
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Table 14 Transition probabilities in the renal disease complication model
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Table 15 Transition probabilities in the eye disease complication model
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Table 16 Disability weights
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Airoldi, M., Bevan, G., Morton, A. et al. Requisite models for strategic commissioning: the example of type 1 diabetes. Health Care Manage Sci 11, 89–110 (2008). https://doi.org/10.1007/s10729-008-9056-9

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