Peripatetic intravenous service for metabolic bone disease: case study in patient centred-care for new NHS

Abstract

Objective:

To develop a ‘close to patient’ peripatetic intravenous service (PIVS) for delivery of specialist osteoporosis care in a community setting without increasing cost and with a reduced carbon footprint.

Research design and methods:

Cost and feasibility of a PIVS for intravenous (i.v.) bisphosphonate treatment were modelled using UK National Health Service costings and then tested in the field for 1 year. Average patient mileage to peripatetic sites was compared with mileage travelled if treated at the base hospital (current practice). The method of travel to hospital (current practice) or peripatetic sites (new study) was ascertained together with patients’ preference for the new or the current system. Peripatetic sites were researched and those with suitable facilities selected. Data for fuel consumption were based on a usage of 1 litre per 14.5 km.

Main outcome measures:

The main outcome measure was cost comparison between hospital and peripatetic services. Others included patient satisfaction, miles saved, method of travel to the clinic and changes in CO₂ emissions.

Results:

Cost per patient, including drugs, lies between £557 and £622 annually for 1000 and 500 patients, respectively which is cost-neutral compared with hospital attendance. PIVS was rated more convenient by 98% of patients. Hospital transport was significantly reduced and the total monthly saving of 2000 miles has reduced CO₂ emission by 6072 kg p.a. No medical emergency occurred in 410 infusions.

Conclusions:

PIVS is cost neutral compared with a conventional service, leads to a better patient experience, a significant cutback in hospital transport costs and a reduction of the NHS carbon footprint. However not all drugs may be suitable for this service: the area served was rural with large distances and poor public transport and mileage savings may not accrue in urban areas. Insurance was not included in the calculation of costs.

Key words::

• Bisphosphonates
• Community
• Cost effectiveness
• Intravenous infusion
• Peripatetic

Transparency

Declaration of funding

Development of the service was conducted in collaboration with primary care trusts in Shropshire and was supported by a grant-in-aid from Novartis Pharmaceuticals UK Ltd.

Declaration of financial/other relationships

M.D. has disclosed that he has received fees for lectures; for membership in advisory boards; and for travel to conferences from Procter and Gamble, MSD, Novartis and Roche.

P.M. has disclosed that he has received fees for consultancy, honoraria and travel to international conferences from several manufacturers of treatments for osteoporosis and metabolic bone diseases including Novartis. F.A. has disclosed that he is an employee of Novartis. The other authors have no associations to disclose.

Acknowledgement

The authors have disclosed that they had no outside editorial assistance in preparing this manuscript.

A presentation based on this work was given to the 31st Annual Meeting of the American Society for Bone and Mineral Research, 11–15 September 2009, Colorado Convention Center, Denver, CO, USA.

The views expressed in this publication are those of the authors and not necessarily those of the publisher or sponsor.