Health Service Focus

Intelligent diagnosis

Professor Walter Van Dyck, associate professor of innovation management at Vlerick Leuven Gent Management School, describes the implications of a recent economic analysis of the use of technology to improve diagnosis.

Potential savings of over 35% are possible could be achieved in the NHS through better use of IT to create a “more sophisticated” system of diagnosis.

Research conducted by the think tank Science|Business demonstrates the savings that could be made by applying new technologies to the screening of common diseases.

The report states: “New information and communications technologies — embodied in e-health systems — are key to unlocking the benefits of personalised healthcare1.”

NHE spoke to Professor Walter Van Dyck, who led the studies in Brussels. Calculating the health technology impact of adopting a new practice, the research concluded that while extensive up-front investment would be necessary, it could cut costs with no loss of efficacy.

What if?

The studies focused on screening for breast cancer and prevention and monitoring of cardiovascular disease, using technology to run simulations of a new system that identified patients according to high or low risk. These ‘what if?’ scenarios aimed to provide costeffectiveness models and analysis of the return on investment.

Prof Van Dyck said: “For breast cancer, if we can stratify the population better, we can get massive cost savings. That’s the main outcome. In the cardiovascular disease area, better telemonitoring options for patients could also get more cost savings and higher quality of life.”

The approach the researchers propose is to test more int e l l i g e n t l y , using smart screening. This is based upon classifying data from published health records in relation to high and low risk.

The high risk is then treated more aggressively, amounting to “serious cost reductions”.

“Obviously there’s always a minus side,” he warned: “The minus side is that you have to invest in a public health records system, which is of course not that cheap. The return on investment on our model is about seven years.”

QALY (quality-adjusted life year) was used to measure the cost-effectiveness of the models and assess the value of different treatments for the same disease.

The proposed model would justify the reduction of screening for breast cancer based on a patient’s risk profile. The screening is based on family history, genotype, life habits and treatment, thereby eliminating many women who present a very low risk of developing the disease.

This practice, based on a risk calculation, is not currently used in the NHE in England in such a systematic way, Prof Van Dyck said, and while some doctors could implement it on a small scale, it is “definitely not rolled out just yet in an exhaustive way to the whole of the population”.

In terms of cardiovascular disease, providing high-risk patients with better access to preventative screenings could see the cost of treating heart problems decrease by up to 46%, the research suggested.

Point-of-care technologies for GPs would allow them to perform the necessary tests quickly and cheaply and technology that allowed patients to electronically monitor their own condition, resulted in adherence to prescribed treatment increasing from 30% to 92%.

Implementation hurdles

The funding required is significant, and a major obstacle to achieving the savings identified. Implementation of an electronic health record system (EHR) in the UK would cost around £27bn initial investment, the research suggested. To diagnose all women above 50 years old amounts to around £2bn and as more women reach that age, new tests contribute additional costs, amounting to £150m per year.

Prof Van Dyck commented: “Technically it’s feasible. It is a health policy decision. It’s a matter of money basically: the technology is there, we can do it. But politics has to decide.” The pattern of the diseases considered are serious throughout Europe and the research followed a decision science approach to calculate probabilities for the entire population. This means the conclusions can be applied on a national scale, and cost savings determined.

“I look into economic implications of implementing technology,” Prof Van Dyck said. “The trick to technology implementation in breast cancer is the stratification about screening. The benefit in cardiovascular is in motivating people to live in a different way, keeping people out of the system by having a different lifestyle.”

This presents another significant hurdle to implementation, as altering behaviour can be extremely challenging, as is demonstrated by the poor public health evident in the UK. This could be helped with technology, Prof Van Dyck suggested, but it will take time to change ingrained attitudes.

He said: “People become more aware than before, that is true. If technology can give that extra little push that could help, [but] it’s a slow process, it’s not just a matter of saying the technology is there and ‘look there you go’, it’ll take longer [than that].”

References 1. Van Dyck W, et al. Unlocking the value of personalised healthcare in Europe—breast cancer stratification. Health Policy and Technology (2012) http://dx.doi.org/10.1016/j.hlpt.2012.04.006 The paper on cardiovascular disease will be published in September.

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