Economic evaluation of an innovative central London alcohol recovery service.

Background:

A pilot project with short-term local authority funding sought to examine the introduction of an alternative to A&E for the immediate care of intoxicated patients assessed by London Ambulance Service (LAS) crews.

Patients accessed the service via LAS 999 services in a central London Borough with a high density of entertainment venues, and their eligibility assessed based on a clinical protocol to exclude potentially complex cases. The patients reached the service venue either by an LAS 999 ambulance or ‘booze bus’, and was available on Friday and Saturday nights, and some other ‘high demand’ nights (i.e. Christmas & New Year period).

What was the problem:

An internal evaluation of the pilot found it to be acceptable to staff and patients, clinically safe, and effective at avoiding the need for A&E attendances for the patient group. However, potential commissioners remained unsure of the service’s cost effectiveness or value for money.

How did PHAST help:

A PHAST health economics consultant scoped the client’s precise needs, including delivery within a limited timescale.

PHAST undertook a review of existing health economics and costing evidence in relation to the client group and services concerned; and developed a costing model to compare the costs of the service compared to A&E. The model also examined alternative staffing and capacity scenarios for the service, and determined the thresholds at which the service appeared cost effective.

The report concluded that the service was cost effective with acceptable staffing arrangements and capacity assumptions, and that it represented good value for money to the NHS.

The evaluation also identified a number of un-quantified benefits, including:
– Reduced burden on A&E capacity.
– Improved environment for A&E staff and other patients.
– Reduced travel and down times for LAS vehicles.
– Improved opportunities for alcohol interventions with ‘binge drinkers’.

Impact:

The PHAST analysis and report was well received by the client and contributed to the decision-making to commission the service.