Developing a patient centered model for clinicians to individualise cost effective treatment

Objectives: The objective of this study was to develop a patient centred model which can be used by clinicians for each patient. Methods: Two hypothetical, but realistic, treatments were selected to demonstrate the value of this model, a "modern atypical drug" and a "typical drug". The "modern atypical drug" is more expensive, results in faster return to work, less days in hospital and fewer repeat visits than the "typical drug". The computer based model provides default differences on all of these variables, however, the end user can over write these to allow the cost off-sets to be individualised to each patient they are treating. Results: While the "modern atypical drug" is more expensive on a per day basis ($4.00 vs $0.30), days of treatment can be shorter, hospital stay and doctor visits reduced and days off work lower, making it a less expensive treatment option overall. In the base case, the medication cost of the "modern atypical drug" was $108 more expensive over the year of treatment ($4 per day x 30 days versus $0.30 per day x 40 days). Shorter length of stay (3 versus 10 days at $50 per day) resulted in $350 in savings. Modest savings were gained from fewer doctor visits. Substantial savings would be expected from fewer days off work (14 versus 45 days off work at $100 per day) with around $3,100 saved. Overall savings were $3,432. This model could be adjusted to reflect the expected outcome for each patient. Conclusions: This is exercise demonstrates a novel model design which allows doctors to assess individual patients to determine whether or not they should be considered for more expensive treatments. It is well suited to health care environments in the region.