A Retrospective Audit with Subsequent Cost and Environmental Analysis of a Denosumab Self Injection Programme

Abstract

The Metabolic Bone Health Department, Cardiff and Vale University Health Board, serves a local population of approximately 445 000 people. A retrospective audit of attendance data regarding the Denosumab treatment clinic (the traditional treatment pathway) and the Denosumab Self Injection Programme (SIP) was conducted to determine whether the Self Injection Programme is both cost effective and environmentally beneficial, compared to the traditional treatment pathway. Cost analysis was then conducted by the Finance Department. The audit was conducted over 3 years following the implementation of the service development; 233 patients had enrolled in the program at the time of the audit and 69 had completed 3 years of self- injected treatment. A control group of 497 patients were identified by the service. This group remained on the historical pathway and had consistent attendance activity over the three-year period from 2017 to 2019. Pre and post period activity of all patients on the program was compared, together with the activity for the independent control group. The SIP resulted in a reduction in clinical contacts, with financial analysis showing a total opportunity cost saving per patient of £420 per annum. There were obvious benefits to the patient of a reduced number of visits to a clinical site, which also resulted in an estimated carbon footprint reduction of 59 KG CO2 per patient per annum. The cost analysis is based on our organisation’s 2022 charges. The SIP demonstrates that through focusing on care “closer to home”, it is possible to maximise resources, improve the patient experience through reduced travel and reduce the environmental impact of healthcare.