NICE QOF change hampered by lack of evidence

Quality framework - New QOF indicators will be backed if they cost under £25,000 for each QALY added.

Lack of evidence on cost-effectiveness will limit NICE's ability to compare indicators proposed for inclusion in QOF with those already in the framework, the institute has said.

Detailed guidance on how current QOF indicators and proposed new ndicators will be assessed was published last week.

Indicators will be deemed cost-effective if they cost under £25,000 for each quality-adjusted life year (QALY) added, in line with NICE's usual threshold.

QOF points will be reduced for indicators that are not cost-effective enough to justify further incentives. Indicators requiring further incentives could have their QOF points value increased.

However, NICE acknowledges that assessment of the cost effectiveness of existing indicators will be constrained by a lack of data on the cost-effectiveness of current indicators.

In the absence of appropriate evidence, NICE argues that a judgment should be made on how likely it is that an intervention is cost-effective.

This would be based on the minimum patient benefit required for a given QOF point's value, NICE suggests.

Dr Richard Vautrey, deputy GPC chairman, said that, for many indicators, it would be difficult to find evidence on cost-effectiveness. 'But, if there are gaps in the evidence that does not mean that an indicator is not cost-effective,' he said.

Dr Vautrey pointed out that treatments in primary care were likely to compare favourably in terms of QALYs with interventions elsewhere in the NHS.

'Primary care is an extremely cost-effective way of delivering healthcare,' he said.

Professor Helen Lester, deputy director of the National Primary Care Research and Development Centre, which is leading the review of indicators, said that the new guidance would add transparency to the review process.

'It is really refreshing to have the process spelt out in such a clear way, so that GPs can see how indicators will be assessed,' she said.

She added that the centre was currently approaching practices to review indicators, which was a further opportunity for GPs to influence the development of the QOF.

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