P143
THE ECONOMIC IMPLICATIONS OF IMPROVEMENT IN BLOOD PRESSURE
CONTROL IN PRIMARY CARE DRIVEN BY THE RENAL QUALITY OUTCOMES
FRAMEWORK (QOF) INDICATORS
Irving, J, Hobbs, H, Kilbride, H, Karunaratne, Kingston, R, Stevens, P, Farmer, C
Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust
INTRODUCTION: The introduction of renal indicators into the Quality and Outcomes Framework
(QOF) has promoted monitoring and control of hypertension to a target BP of <140/85. We have
shown that since the introduction of these indicators there has been a highly significant reduction in
blood pressure and an increase in antihypertensive prescription in people with stage 3-5 CKD.
AIM: This study aims to provide a cost benefit analysis of implementing the renal QOF indicators on
blood pressure and antihypertensive medication prescription in people with CKD.
METHODS: Data were extracted as part of the SEIK project* on a total population of 36,519
individuals from primary care during a 4 year study period. The study period was split into two
groups, Pre QOF (Group 1: 1/4/2004-1/4/2006) and post QOF (Group 2:1/4/2006-1/4/2008). Patients
were selected from this data if they had GFR estimations and blood pressure readings in both study
periods. Patient demographics, mean and median GFR, blood pressure and anti hypertensive
prescriptions for each patient in each of the two periods were extracted. Patients were designated as
hypertensive if they had a mean BP >140/85 or were prescribed antihypertensive drugs in the preQOF period. Stage of CKD was also assessed using the mean GFR in the pre-QOF period. An
estimate of the annual cost of treatment of hypertension was made for both study periods based on
prescriptions written. Costs were also calculated on the basis of global generic prescribing.
RESULTS: 32,770 patients had GFR and blood pressure measurements in both study periods.
24,088 of these were hypertensive and 5,901 were both hypertensive and had CKD 3-5 in the pre
QOF period. Our previous study has demonstrated a significant blood pressure reduction in people
with CKD 3-5 (7/3mmHg).
Diuretic
Beta-blocker
Alpha-blocker
Calcium channel
blocker
ACE inhibitor
ARB
Other
Number
624
390
213
pre QOF
Actual
cost £
26,829
10,910
8,280
Generic
cost £
6,065
4,025
7,566
407
2,904
1,166
30
45,736
85,777
191,012
2,955
6,056
51,924
191,012
6,000
5,734
371,499
309,006
Totals
Table showing costs for hypertensive patients with CKD 3-5.
Number
1,780
1,166
430
post QOF
Actual
cost £
38,754
36,527
16,946
Generic
cost £
17,127
11,847
15,203
1,080
2,186
1,451
45
123,585
59,594
235,328
5,625
15,892
38,692
235,328
9,000
8,138
516,358
388,756
CONCLUSION: This study demonstrates that introduction of renal indicators in the QOF has
significantly increased anti-hypertensive prescribing resulting in a 40% increase in prescribing costs.
Payments for achievement of QOF targets will have further increased costs. However, a significant
proportion of these costs would be offset if all drugs were prescribed generically.
The increased cost is approximately £25.00 per patient treated which, given the reduction in blood
pressure achieved is well within the cost effective threshold of £30K per quality adjusted life year
(QALY) outlined in NICE guidelines.
* The SEiK project is a decision support system used in primary care which analyses data on patients
who have had serum creatinine tests.