CONSTRAINTS, CAPACITY AND CAPABILITY: AN APPLICATION OF MATHEMATICAL OPTIMISATION METHODS

Purpose: The National Bloodspot Screening programme (NBSP) requires parental informed consent before testing newborns for inherited diseases. This nation-wide information provision process comes from a constrained supply of midwives. Capability-based outcome measures have gained attention as a way of evaluating healthcare programmes. This study illustrates how optimisation methods can take account of capacity constraints while using measures of capability to value information provision in the NBSP.  

Method(s): Linear programming, a mathematical optimisation technique, was used to identify the optimal parental information approach to as part of the NBSP informed consent process. Responses from a discrete choice experiment (n = 702) comprising 4 attributes (3 process and capability to make an informed decision) were used to populate an objective function that aimed to maximise capability to make an informed decision. The optimal solution was constrained so that monetary and time costs of information provision can be no greater than those of current practice. 

Result(s): The mathematical optimisation results suggested that the types of information given to parents should differ from current practice. Information should be provided during a woman’s pregnancy in an individual discussion supported by a leaflet, rather than after the baby is born, as in the current programme. Adopting this approach could increase parents’ capability to make an informed decision by 145% whilst saving the NHS £50,000 per year and 5097 hours of midwife time.

Conclusion(s): Optimisation techniques, when used alongside cost-effectiveness analysis, have the potential to enhance medical decision making, specifically, when health system capacity constraints are important.