Objective:
To determine if use of Point of Care Testing (POCT
) is less costly than laboratory
testing to the NHS in delivering the NHS Heath Chec
k (NHSHC) programme in the primary
care setting
Design:
Observational study and theoretical mathematical mo
del with micro-costing
approach
Setting:
We collected data on NHSHC delivered at 9 general
practices (7 using POCT; 2 not
using POCT).
Participants:
We recruited 9 general practices offering NHSHC, a
nd a Pathology Services
Laboratory in the same area.
Methods:
We conducted mathematical modelling with permutatio
ns in the following fields:
provider type (HCA or nurse), type of test performe
d (total cholesterol with either lab
fasting glucose or HbA1c), consumables costs and va
riable uptake rates including rate of
non-response to invite letter and rate of missed (D
NA) appointments. We calculated Total
Expected Cost (TEC) per 100 invites, number of NHSH
C conducted per 100 invites and costs
for completed NHSHC for laboratory and POCT-based p
athways. A univariate and
probabilistic sensitivity analysis was conducted to
account for uncertainty in the input
parameters.
Main outcome measures:
We collected data on cost, volume and type of path
ology services
performed at seven general practices using POCT and
a Pathology Services Laboratory. We
collected data on response to the NHSHC invitation
letter and DNA rates from two general
practices. Results:
TEC of using POCT to deliver a routine NHSHC is low
er than the laboratory-led
pathway with savings of £29 per 100 invited patient
s up the point of CVD risk-score
presentation. Use of POCT can deliver NHSHC in one
sitting, whereas the laboratory
pathway offers patients several opportunities to DN
A appointment.
Conclusions:
TEC of using POCT to deliver an NHSHC in the prima
ry care setting is lower
than the laboratory-led pathway. Using POCT minimiz
es DNA rates associated with
laboratory testing and enables completion of NHSHC
in one sitting.