Quantification of benefits

^{Quantitative estimates were estimated for the potential efficiency gains associated with the cases previously discussed. These estimates are based upon the findings from the more successful case studies and extrapolated for each of the 27 EU Member States and the UK as well as to the aggregate European level (EU27+UK). These quantifications provide an indicative estimate of the scale of potential efficiency gains that could be realised, but they must be interpreted with some caution. Many of the cases were based on small trials (e.g. the Lean Sigma Six clinical surveillance programme in Italy), whilst in other cases the results are based on models rather than observed outcomes (e.g. colorectal cancer screening in the Basque country, Spain). Finally, many of the health benefits and cost savings associated with these interventions will only be realised in the future (e.g. the full cost and survival benefits of colorectal cancer screening will accrue over a 30-year period).}

4.1 Quantification 1: Efficiency gains from colorectal cancer screening

The CRC screening extrapolation was based on simulating life expectancies for a hypothetical cohort accounting for national demographic characteristics, including health status. These simulated cohort outcomes were combined to produce aggregate measures of costs and health outcomes.

Each scenario combines information on the intervention, including costs, eligibility and participation rates, and expected efficacy to estimated expected outcomes. These outcomes include changes in incidence, mortality, length of stay, resource utilisation (for example, follow-up procedures, treatments), direct health care costs, life expectancy, and quality-adjusted life-years (QALYs).

^{Participation rates of 45% and 72% in all EU27+UK would translate to an additional 171,000 to 331,000 QALYs per year, respectively. Using a willingness-to-pay of €30,000 per QALY implies an annual efficiency gain of between €5.1 and €9.9 billion as a result of CRC screening, in addition to savings associated with treatment costs avoided.}

4.2 Quantification 2: Efficiency gains from disease management programmes for chronic obstructive pulmonary disease

DMPs for COPD have the potential to reduce COPD-related hospitalisations and mortality, contributing to substantial gains in efficiency. To estimate the baseline cost of COPD admissions in the EU27+UK, information on COPD prevalence, the annual rate of hospital admission, and the mean length of hospital stays along with estimates of the cost per inpatient bed day were combined.

We tested 75% and 50% compliance rates with the DMP, and lower and upper COPD hospitalisation rates of 12% and 38% for the sensitivity analysis. The case study observed that the DMP for COPD also impacted mortality rates, suggesting a relative 87% reduction in mortality (1.9% vs. 14.2%). This reduction was assumed to be constant across the EU27+UK and was factored into the calculations.

^{For the EU27+UK, these calculations suggest savings between €204.5 and €648.1 million in the 50% DMP compliance scenario, and between €690.2 million and €2.1 billion in the 75% DMP compliance scenario, as well as up to 17,000 premature deaths avoided.}

4.3 Quantification 3: Efficiency gains from rational use of medicinesing

Addressing inappropriate polypharmacy through medication review has the potential for substantial efficiency gains by improving disease management, avoiding adverse outcomes, and potentially reducing prescribing costs. To illustrate the scale of potential efficiency gains associated with a systematic prescription review programme, a simulation analysis based on the outcomes observed in the Scottish case study was performed.

For the purposes of the analysis, polypharmacy was defined as the use of 10 or more medications daily. On the basis of nationally representative UK micro-data, the prevalence of polypharmacy was estimated to be 2.7% in the UK. The potential cost savings associated with different levels of population uptake and the net effects of reviews, including the rationalisation of medicines and a lower risk of hospitalisation due to adverse interactions, were estimated. Medicine rationalisation represents the net change in the number of medicines per individual and can include additional medicines for some patients and reductions for others. For sensitivity analyses, a population uptake over a range of 10-100% and average net medication reductions of 20-60% were adopted.

^{For the EU27+UK, the total expected value of a medication review programme aiming at a rational use of medicines would be of €1.2 billion, ranging from €150 million in the most pessimistic scenario (0.01% of the total health expenditure of the EU27+UK) to €2.3 billion in the most optimistic scenario (0.153% of total health expenditure).}

4.4 Quantification 4: Efficiency gains from reducing healthcare-associated infections

The size of the potential efficiency gains associated with clinical surveillance programmes to reduce HCAIs was estimated using the results of the evaluation of the more successful case, the Lean Sigma Six clinical surveillance intervention in Italy. Improta et al. (2018) estimate a 43% to 49% reduction in the incidence of HCAI and an EU27+UK incidence of HCAI in 7.1% of all patient admissions was assumed. This represents approximately 7 million patients in the EU27+UK each year.

^{For the EU27+UK, potential cost savings associated with a reduction in the incidence of HCAIs would be in the range of €3.6-4.0 billion, along with up to 15,000 to 18,000 deaths avoided.}