Health economics — Patient Pathway

// A referral-to-outcome patient pathway, with the economics of the
// three pathways it splits into. Three checks run at once here: the
// exclusions must account for every patient who left, the three arms
// must sum back to the cohort they were drawn from, and the readmission
// rates must match the counts they are computed from.

econ_model pathway {
  title: "Community versus hospital heart-failure follow-up"
  perspective: "health-system"
  currency: "GBP"
  horizon: "5y"
  discount: 0.035
}

intervention hospital_led {
  name: "Hospital-led follow-up (current pathway)"
  cost: 8940
  qalys: 3.12
  arm: "standard-of-care"
}

intervention community_led {
  name: "Community heart-failure nurse pathway"
  cost: 7420
  qalys: 3.41
  comparator: hospital_led
  arm: "treatment"
}

intervention remote_monitored {
  name: "Remote monitoring with nurse escalation"
  cost: 6980
  qalys: 3.33
  comparator: hospital_led
  arm: "treatment"
}

// ── The pathway. 4 820 referred, 3 612 allocated.
cohort referred {
  n: 4820 source "Referral registry, 2024 to 2025"
}

cohort assessed {
  n: 4413
  from: referred
  excluded: {
    referral_withdrawn: 268
    did_not_attend_assessment: 139
  }
}

cohort eligible {
  n: 3860
  from: assessed
  excluded: {
    ejection_fraction_out_of_range: 391
    comorbidity_exclusion: 162
  }
}

cohort allocated {
  n: 3612
  from: eligible
  excluded: {
    declined_pathway_change: 174
    moved_out_of_area: 74
  }
}

// The three arms must sum to the cohort they are drawn from.
arm hospital_arm {
  n: 1204
  from: allocated
  intervention: "Hospital-led follow-up"
}

arm community_arm {
  n: 1210
  from: allocated
  intervention: "Community heart-failure nurse pathway"
}

arm remote_arm {
  n: 1198
  from: allocated
  intervention: "Remote monitoring with nurse escalation"
}

// The declared rates are recomputed from the counts beside them.
outcome readmission_12m {
  metric: "Any heart-failure readmission within 12 months"
  role: "primary"
  timepoint: "12 months after allocation"
  control:   { events: 313, n: 1204, rate: 26.0% }
  treatment: { events: 254, n: 1210, rate: 21.0% }
  test: "chi-squared"
  p: 0.004
}

view ce: ce_plane
view referral_flow: consort(referred)