Investigating the Costs and Benefits of ICT Use in Personalized Healthcare: A Case-Based Approach

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1 Investigating the Costs and Benefits of ICT Use in Personalized Healthcare: A Case-Based Approach Walter Van Dyck, Daniel Gassull, Gergely Vértes, Prateek Jain, Muhilan Palaniappan, and Erik Tambuyzer

2 Does technology-enabled personalisation allow for a move from pure play drug-based to integrated healthcare solutions? PREDICTION PREVENTION TREATMENT MONITORING Breast Cancer Case Study Acute Coronary Syndrome Case Study For both cases we studied; 1. Cost Effectiveness analysis and impact on various healthcare players 2. Cost-Benefit analysis: NPV, IRR, sensitivity analysis 2 07/06/2012

3 Unlocking the Value of Personalised Healthcare in Europe Breast Cancer Stratification (2012) and Unlocking the Value of Personalised Healthcare in Europe Cardiovascular Disease Prevention, Diagnostic and Telemonitoring Technology (2012) In Health Policy and Technology, forthcoming Walter Van Dyck 1, Daniel Gassull 1, Gergely Vertes 1, Prateek Jain 1, Muhilan Palaniappan 1, Duane Schulthess 2, Erik Tambuyzer 2, Richard Hudson 2, Nuala Moran 2 1 Vlerick Leuven Gent Management School, Reep 1, 9000 Gent, Belgium 2 Science Business, Rue Belliard 197, Box 12, 1040 Brussels, Belgium 3 07/06/2012

4 07/06/ Case Study 2: Acute Coronary Syndrome

5 Secondary Care Chest pain Primary Care Surgery Diagnosis ACS Current Treatment Scenario (Simplified) Based on the clinical guidelines of European Society of Cardiology Medication Treatment Medication Non- Stable Angina ACS Free Symptom GP + Unstable Angina AMI Angioplasty (PCI) Non- CABG (Bypass) ER Our data is Based on: Cost: Acute coronary syndromes in Europe: 1-year costs and outcomes (York Health Economic Consortium Ltd.) Taylor MJ, Scuffham PA, McCollam PL, Newby DE.) Probabilities: Actual Patient Data (Belgian patient sample) with Dr. Frank Buntix (GP) and Dr. Marc Sabbe (UZ Leuven). 5 07/06/ ER + Non-

6 Primary Prevention Definition Primary prevention generally involves the prevention of disease and conditions before their biological onset. In our analysis we used physical activity as a proxy to represent primary prevention Cost impact considered Subsidizing weekly exercise to high risk citizens, National awareness campaign promoting exercise 6 07/06/2012

7 Primary Prevention Exercise, Lifestyle intervention program Chest pain Secondary Care Surgery Primary Care Diagnosis Primary Prevention: Model impact Per patient INVESTMENT Cost/year Impact description Primary Prevention 400 Reduction of 10% of incidence rate. Medication Non- Stable Angina GP ACS Free Symptom + Unstable Angina AMI Non- PCI (Angioplasty) ER CABG (Bypass) Non- Prevention Incidence Rate Reduction by 10%. ER /06/

8 Point of Care technology 8 07/06/2012 Definition Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing.(1) Representational technology used: I- Stat (Abbott) Advanced handheld and test cartridge blood analysis system that delivers Lab-quality results Commercially available but not reimbursed yet in Europe. Biosensor technology enables patient side blood testing, Real time data within minutes rather than hours

9 Primary Prevention Secondary Care Surgery Chest pain Exercise, Lifestyle intervention program Point of Care Technology Primary Care Diagnosis Point of Care technology: Model impact Per patient INVESTMENT Cost/year Impact description Treatment POC Technology 800 Cost of blood test reduced & a reduction of ER as a first point of contact by 5%. Medication Stable Angina Non- GP ACS Free Unstable Angina Symptom + AMI PCI (Angioplasty) Non- ER CABG (Bypass) ER + Non- 9 07/06/ The cost of POC varies by country.

10 Tele-health monitoring programs 10 07/06/2012 Definition The use of electronic information and telecom technologies to support long-distance clinical healthcare, health related education, public health and health administration. Representational technology used: Health Buddy (Bosch) Connects patients in their homes to their care providers claimed to increase to medication to 94% Compatible devices: Blood glucose, blood pressure, weight scale (not considered)

11 Primary Prevention Chest pain Secondary Care Surgery Exercise, Lifestyle intervention program Primary Care Diagnosis Telemonitoring Tele-health monitoring: Model impact Per patient INVESTMENT Cost/year Impact description Treatment Tele-health monitoring 1200 Increase of to medication from 34% to >60%. Reduction of hospital admission by 10%. Telemonitoring Medication Non- Stable Angina GP ACS Free Symptom + Unstable Angina AMI PCI (angioplasty) Non- ER CABG (Bypass) ER + Non /06/

12 RESULT 1: Increases in QALY shows that all three interventions should be implemented (UK data shown) Health Care Intervention Δ Cost ( ) Δ QALY INB ( ) IHB (QALY) Primary Prevention (exercise) Point of Care Technology (remote testing) Tele-Health Monitoring 292 0, , , , , ,104 TOTAL (3 Technologies combined) -3164* 0, ,126 *Interventions impact different populations sizes based on probabilities and do not sum vertically INB= Incremental Net Monetary Benefit ( ) IHB= Incremental Health Benefit (QALY) WTP = Willingness to Pay ( 35k / QALY) Science Business ICT in Personalized Health

13 Average direct healthcare cost per patient Cost reduction achieved by the 3 interventions in the analyzed 3 countries: - 46% - 33% - 30% 13 07/06/2012

14 RESULT 2: Reduced incidence of ACS and doubling of healthy citizens in the cohort population (UK data shown) 1 Intervention Impacts 0,9 0,8 0,7-15% - 13% + 250% 0,6 0,5 0,4 Current Scenario Investment Scenario 0,3 0,2 0,1 0 Stable Angina Unstable Angina ACS free Science Business ICT in Personalized Health

15 RESULT 3: Cost effectiveness of ACS after implementation of three interventions assuming 70% (UK data shown) Science Business ICT in Personalized Health

16 1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0 0,6 0,5 RESULT 4: Reduced healthcare consumption and increased utilization of less costly pathways (UK data shown) Current Scenario ER consumption 1-15% 0,9 0,8 + 5% Investment Scenario 0,7 0,6 0,5 0,4 0,3 0,2 0,1 Treatment Consumption 0 Current Scenario - 14% GPs consumption Investment Scenario 0,4 0,3 0,2 0,1-59% - 59% - 17% - 13% 0 Catharization Angioplasty PCI Bypass CABG Medication Science Business ICT in Personalized Health

17 M RESULT 5: Cost of Operation and Savings of Each Intervention (UK data shown) , Avg. Annual Cost -109,5-198,5 131,6 80 Avg. Annual Savings Telemonitoring Point of Care Prevention , /06/2012

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