Purpose: Significant resources are allocated to quality improvement (QI), yet little is known about the costs and benefits of QI adherence. We developed a framework for measuring the value of QI activities and provide a worked example using the 2006 Healthcare Effectiveness Data and Information Set (HEDIS) measures.
Method: Our framework identifies the QI measures and setting(s) of interest and synthesizes QI cost-effectiveness data. For each measure, we: (1) quantify current compliance rates; (2) review literature and abstract CE data (incremental cost-effectiveness ratio, ICER); (3) estimate per-person steady-state cost and quality-adjusted-life-year (QALY) impacts; (4) calculate ICERs at current and full compliance levels based on calculated total costs and total QALYs; (5) perform sensitivity analyses to evaluate the impact of model assumptions on results. We applied this framework to 18 widely used US HEDIS measures. We defined full compliance as 95% and considered two types of costs: those of providing the clinical service (e.g., giving the vaccination to a patient in the case of a vaccination-related QI measure) and those of improving QI compliance (e.g., efforts to convince patients to be vaccinated). We assumed that only QI-improvement costs varied with compliance, with these costs in the base-case increasing linearly with compliance and in sensitivity analyses increasing exponentially, decreasing exponentially, and not changing with compliance.
Result: In the worked example, the literature search for cost-effectiveness data of 18 HEDIS measures yielded 1,901 articles; 1,629 were excluded and the remaining 272 articles were reviewed. After applying the framework, we estimated that increasing HEDIS compliance to 95% improved health but increased cost, with our framework-calculated ICERs for the individual HEDIS measures ranging from $180/QALY (alcohol/drug dependence treatment) to $39,805/QALY (breast cancer screening), with a median of $9,791/QALY (glaucoma screening). Overall, optimizing HEDIS compliance to 95% with all 18 measures was estimated to cost $12.3 billion and to save approximately 6 million QALYs, resulting in a mean ICER $2,087/QALY.
Conclusion: We demonstrated the utility of our framework for quantifying value of QI programs like HEDIS, showing that improving compliance with such measures can be an efficient way to improve health. This framework can be a useful tool in quantifying and comparing the value of QI activities and health care interventions to aid decision-makers in resource allocation decisions.
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