Economic Analysis of Social Prescribing’s Effects on Providers

Social Prescribing is a new medical movement in the UK with millions in funding. But does it have a positive ROI?

Photo by Dan Burton on Unsplash

Read more about Social Prescribing here and here and ohhhh here too!

Here’s what I’ve found so far.

Social prescribing seems to have mixed economic results, leaning towards positive bottom-line impact on practices. There is room for more robust evidence. Many studies are not randomized controlled trials (RCTs) or peer reviewed and all face the inherent challenges of conducting research on such a complex intervention. Note that all studies below are based in the UK, except one from Canada.

Studies:

• Marie Polly/U Westminster 2017 Review of the collection of 14 studies, average decrease in primary care by 28%, average decreases in accident and emergency visits (A&E) by 24%. Secondary care referrals dropped in two studies (55% past 12mo and 64% past 18mo), yet one study showed doubling of secondary care mental health referrals.
• Pilot study in Rotherham (N=1,607 patients) estimating £1.41 to £3.38 ROI per pound over 5 years; found reduction of inpatient admissions (21%), Accident and Emergency (A&E) attendances (~20%), outpatient appointments (21%). Note: % are of partial data to be refined in future
• Tower Hamlet practices (N= 2,270 patients) across 8 months; found 12.3% reduction of patient appointments when comparing the 6 months before and 6 months after meeting with a Community Link Worker.
• Wellbeing Programme 2014 Pilot (N=168 patients) found more patient phone consultations in the immediate year following the intervention, but a reduction in the second year. In the second year, 60% of providers (N=37 providers) saw reduction in face to face consultations, while 14% saw an increase. 50% of providers (N=40 providers) saw a reduction in phone consultations, while 26% saw an increase.
• In London, providers were able to deliver social prescribing at costs of £7.80, £3.75, and £3.60 per patient (Camden N=10,500 patients; Dorset N=3,000, Liverpool N=26,000 respectfully)
• City and Hackney controlled pilot (N = 237 patients), the average SP cost per patient was between £225 and £270. Savings may have been realized through a decline in A&E attendance, but may have been offset by an increase in GP consultation frequency during the intervention period.
• Brighton & Hove SP Pilot (N = 361 SP patients) found total net gain to health system of £1,500 per client per year. Note: study methods not shared
• Ontario AHC pilot of SP for (N=1,101 patients) saw decrease in repeat client visits of 4.8% at 3 months and 41.8% at 9 months (providers N= 21, 31 self-reported respectively)
• A RCT with Amalthea Project as a referral facilitator in 2000, BMJ, (N=161) showed positive health outcomes at higher cost — £153 to referral organization vs. £133 per patient to general practice.

I’ll add to this list as I come across more studies.

My Next steps:

1. Build an initial financial model for Social Prescribing in the US(draft here)
2. Get feedback on model from prominent healthcare economists

To you, dear reader, any other cost-analysis studies we should include here? Leave a comment.