PT  - JOURNAL ARTICLE
AU  - Simon Walker
AU  - Anne R Mason
AU  - Karl Claxton
AU  - Richard Cookson
AU  - Elisabeth Fenwick
AU  - Robert Fleetcroft
AU  - Mark Sculpher
TI  - Value for money and the Quality and Outcomes Framework in primary care in the UK NHS
AID  - 10.3399/bjgp10X501859
DP  - 2010 May 01
TA  - British Journal of General Practice
PG  - e213--e220
VI  - 60
IP  - 574
4099  - http://bjgp.org/content/60/574/e213.short
4100  - http://bjgp.org/content/60/574/e213.full
SO  - Br J Gen Pract2010 May 01; 60
AB  - Background The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF may offer poor value for money.Aim To assess the cost-effectiveness of QOF payments.Design of study Economic analysis.Setting England, UK.Method Cost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the cost-effectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices.Results Average indicator payments ranged from £0.63 to £40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed.Conclusion For most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.