Mathematical model of referral marketing strategy

A marketing strategy is an attempt to campaign for a product so that information about the product becomes viral. Advertising strategy began to be combined by involving customers to campaign for the company’s products. This marketing strategy is known as the referral marketing strategy. Viral information in a community can be analogous to the pandemic condition of a disease. This study aims to examine the relationship between the epidemiological model and the marketing model with a referral strategy. This research is a literature study with the results of a marketing model design with a referral strategy. Based on the research, there are 4 groups in marketing modeling with a referral strategy, namely Unaware, Potential Broadcaster, Broadcaster, and Inert. The epidemiological model that is suitable for this condition is the SEIR model. Adjustments to the SEIR Model need to be made because the dynamics of the Unaware can go directly to the Inert because of the trust factor in marketing information. The simulation results show that the parameters that have an important role in making information viral are the customer network and the incubation time of the information becoming viral.

Factors influencing upward referral system of patients in Nairobi County

Background: The referral system forms main health systems coordinating a mechanism ensuring the harmonious movement of patients between different levels of health care institutions for effective and efficient service delivery. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Methods: Cross-Sectional data collected from 204 respondents from 2May to 30June, 2021, through a structured questionnaire from level 3-5 public facilities in Nairobi County was used. Data was analyzed using SPSS. Doctors, nurses and clinical officers who have referred patients in the previous three months were included while those who had not were excluded.Results: Bivariate analysis results revealed that knowledge of referral system (r=179*, p=0.011) and complexity of patient disease (r=097, p=0.170) had positive and significant correlation with upward referral system. Multivariate analysis results showed that proximity to the referral health facility had positive and statistical significant (β4=0.640, p<0.002) to upward referral system.Conclusions: The results revealed that although healthcare workers know about the referral strategy, they lack full comprehension of the referral strategy. Patients are mostly referred when higher diagnostic equipment are needed and when the medical conditions are dire. The study recommends professional medical education to equip the human resources for health with the requisite knowledge on the referral system and establishment of effective communication systems between the lower levels health facilities and the higher or specialized facilities to ensure there a smooth referral system in Nairobi County.

Introducing the non-invasive prenatal testing for detection of Down syndrome in China: a cost-effectiveness analysis

ObjectiveThis study aimed to compare the health economic value of a non-invasive prenatal testing (NIPT) strategy against a second-trimester triple screening (STS) strategy for the detection of Down syndrome based on real-world data from China.DesignA decision-analytical model was developed to compare the cost-effectiveness of five strategies from a societal perspective. Cost and probability input data were obtained from the real-world surveys and published sources.SettingChina.ParticipantsWomen with a singleton pregnancy.InterventionsThe five strategies for screening were: (A) maternal age with STS (no NIPT); (B) STS plus NIPT screening; (C) age-STS plus NIPT screening (the currently referral strategy in China); (D) maternal age with NIPT screening and (E) universal NIPT screening.Main outcome measuresIncremental cost-effectiveness ratios (ICERs) per additional Down syndrome case terminated, univariate and probabilistic sensitivity analysis and cost-effectiveness acceptability curves were obtained.ResultsStrategy A detected the least number of Down syndrome cases. Compared with the cheapest Strategy B, Strategy D had the lowest ICER (incremental cost, US$98 944.85 per additional Down syndrome case detected). Strategy D had the highest probability of being cost-effective at the willingness-to-pay level between US$110 000.00 and US$535 000.00 per additional Down syndrome case averted. Strategy E would not be cost-effective unless the unit cost of the NIPT could be decreased to US$60.50.ConclusionIntroducing NIPT screening strategies was beneficial over the use of STS strategy alone. Evaluating maternal age in combination with the NIPT screening strategy performs better than China’s currently referral strategy in terms of cost-effectiveness and safety. Lowering the price of NIPT and optimising payment methods are effective measures to promote universal NIPT strategies in China.

Current NAFLD guidelines for risk stratification in diabetic patients have poor diagnostic discrimination

Patients with type 2 diabetes (T2D) are at risk for non-alcoholic fatty liver disease (NAFLD) and associated complications. This study evaluated the performance of international (EASL-EASD-EASO) and national (DGVS) guidelines for NAFLD risk stratification. Patients with T2D prospectively underwent ultrasound, liver stiffness measurement (LSM) and serum-based fibrosis markers. Guideline-based risk classification and referral rates for different screening approaches were compared and the diagnostic properties of simplified algorithms, genetic markers and a new NASH surrogate (FAST score) were evaluated. NAFLD risk was present in 184 of 204 screened patients (age 64.2 ± 10.7 years; BMI 32.6 ± 7.6 kg/m2). EASL-EASD-EASO recommended specialist referral for 60–77% depending on the fibrosis score used, only 6% were classified as low risk. The DGVS algorithm required LSM for 76%; 25% were referred for specialised care. The sensitivities of the diagnostic pathways were 47–96%. A simplified referral strategy revealed a sensitivity/specificity of 46/88% for fibrosis risk. Application of the FAST score reduced the referral rate to 35%. This study (a) underlines the high prevalence of fibrosis risk in T2D, (b) demonstrates very high referral rates for in-depth hepatological work-up, and (c) indicates that simpler referral algorithms may produce comparably good results and could facilitate NAFLD screening.

OP0279 THE IMPACT OF A REFERRAL STRATEGY FOR AXIAL SPONDYLOARTHRITIS: 12 MONTHS FOLLOW-UP OF PATIENT REPORTED OUTCOMES

Background:Early recognition of axial spondyloarthritis (axSpA) patients is difficult for general practitioners within the large amount of chronic low back pain (CLBP) patients1. As a result, several referral strategies have been developed to help physicians identify patients at risk for axSpA. Most referral strategies were developed in secondary care patients with no available data on their impact. The only referral strategy that was developed and validated in primary CLBP patients is the Case Finding Axial Spondyloarthritis (CaFaSpA) strategy, but required an impact analysis before implementation in daily clinical practice2-3.Objectives:The purpose of this study was to assess the impact of using the CaFaSpA referral strategy on patient reported outcome outcomes (PROs) in primary care patients with CLBP at risk for axSpA.Methods:A clustered randomized controlled trial was performed in a primary care setting in the Netherlands. (ClinicalTrials.gov Identifier:NCT01944163). Each cluster contained the general practices from a single primary care practice and their included patients. Clusters were randomized to either the intervention (use of CaFaSpA referral strategy) or the control group (usual care). Primary outcome was disability after 12 months. Secondary outcome was quality of life, pain and fatigue after 12 months. A linear mixed-effects model was used to explore the effects over time according to intention to treat analysis.Results:In total 679 patients were included within 93 GP clusters. Sixty-four percent of our study population were female and mean age was 36 (7.5) years. Overall RMDQ reduced over time both in the intervention and control group (figure 1). The difference in decrease was not statically significant between the groups (p-value 0.81).Figure 1.Estimated mean RMDQ scores over time for the overall intervention and usual care group.EQ-5D increased by 0.03 after 12 months within the intervention group and 0.01 in the control group (not significant) (table 1). The decrease in pain and fatigue did not differ significantly between the intervention and control group.Table 1.Mean change in PROs after 12 months in the intervention and control groupPROsInterventionUsual careBaseline12 monthsp-valueBaseline12 monthsp-valueEQ-5D mean (SD)0.69 (0.26)0.72 (0.27)0.140.72 (0.24)0.73 (0.25)0.53VAS-pain mean (SD)5.03 (2.42)4.68 (2.69)0.074.96 (2.42)4.55 (2.69)0.02VAS-fatigue mean (SD)5.19 (2.50)5.01 (0.21)0.355.23 (2.45)4.86 (2.73)0.04Conclusion:Although the functional disability due to pain reduces over time, there was no positive effect by referring based on the CaFaSPA model. Further data on PROMs for the axSpA patients are under investigation.References:[1]Jois RN et al. Rheumatology (Oxford) 2008;47:1364-1366.[2]van Hoeven L et al. PLoS One 2015; 22;10(7):e0131963.[2]Moons KG et al. Heart 2012;98(9):691-8.Disclosure of Interests:None declared

OP0282 COST-EFFECTIVENESS ANALYSIS OF A CAFASPA REFERRAL MODEL FOR AXIAL SPONDYLOARTHRITIS

Background:Chronic low back pain (CLBP) poses a significant individual and socio-economic burden. A substantial amount of patients with CLBP have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs). Guidelines form primary care and secondary care differ in criteria for referral recommendation. The Dutch primary care guideline is restrictive in referring CLBP patients to secondary care whereas ASAS recommend to refer CLBP patients having at least 1 axSPA feature1. Therefore several referral models have been developed to assist GPs. Although the validated CaFaSpA referral model2is able to identify CLBP patients at risk for axSpA, its cost-effectiveness is yet unknown and essential before implementation in daily clinical practice.Objectives:Primary objective to assess the cost-effectiveness of the CaFaSpA referral model for axSpA in primary care. Secondary objective to evaluate the costs made for screening by following the CaFaSpA vs ASAS referral model.Methods:A clustered randomized controlled trial was performed with GPs as clusters. Clusters were randomized into the intervention (CaFaSpA referral, CS) or usual care (UC). Cost-effectiveness analysis from a societal perspective was performed to compare the CS and UC. Clinical outcomes were disability (Roland-Morris Disability Questionnaire (RMDQ)) and health-related quality of life (EuroQol (EQ-5D)) after 12 months. Direct (Medical Consumption Questionnaire IMCQ) and indirect healthcare (Productivity Cost Questionnaire IPCQ) costs were evaluated. Complete case analysis was performed. Incremental cost-effectiveness ratios (ICERs) were calculated for both clinical effects. Fictive costs according to the Dutch standard prices were assessed if the ASAS guideline would be followed (screening costs)3.Results:Of all 679 patients sixty-four percent were female and mean age was 36 (SD) years. In the CS 333 patients were included and in the UC. Non-significant differences in clinical outcomes were for RMDQ: 0.78 (95% CI: -0.38-2.07) and for EQ5D 0.03 (95% CI: -0.04-0.11). Costs were significantly higher in the UC group €19,748 (95% CI: € 15,327-25,022) vs CS € 14,169 (95% CI: € 10,723-18,066).Productivity loss was the largest contributor to the total costs (CS group: 62%, UC group: 96%). The majority of the bootstrapped ICERs presented were located in the south-eastern quadrant of the cost-effectiveness planes (Figure 1a and 1b), indicating that the CS is cost-effective. The ICER for RMDQ was €-5,579, indicating that per point improvement on the RMDQ the intervention saved €5,579. The difference in QALY’s between the CS and UC was very small resulting in a large ICER of €16,9583.The fictive screening costs by using the ASAS referral advice, i.e. referring 85% of 679 patients, results in €876 per patient. The total screening costs per patient by using the CaFaSpA model, i.e. referring 60% of 679 patients is €618.Conclusion:Although the clinical effects between the CaFaSpA referral strategy and usual care were comparable, the CaFaSpA referral strategy resulted in a better cost-effectiveness. Lower costs were mainly driven by the increased productivity.References:[1]Poddubnyy D et al. Ann Rheum Dis 2015;74:1483–7.[2]van Hoeven L et al. PLoS One 2015; 22;10(7):e0131963.[3]van Hoeven L et al. Ann Rheum Dis 2015;74(12):e68.Disclosure of Interests:None declared

Uveitis in spondyloarthritis

Uveitis is the most frequent extra-articular manifestation of axial spondyloarthritis (SpA), occurring in up to one-third of the patients. In the majority of patients, uveitis is acute, anterior and unilateral and presents with photosensitivity, sudden onset of pain and blurred vision. Topical steroids are an effective treatment; however, recurrent or refractory cases may need conventional disease-modifying antirheumatic drugs or biological treatment with monoclonal tumor necrosis factor (TNF) inhibitors, thus also influencing treatment strategy of the underlying SpA. Though the exact pathogenesis of SpA and uveitis remains unknown, both seem to result from the interaction of a specific, mostly shared genetical background (among other HLA-B27 positivity), external influences such as microbiome, bacterial infection or mechanical stress and activation of the immune system resulting in inflammation. Up to 40% of patients presenting with acute anterior uveitis (AAU) have an undiagnosed SpA. Therefore, an effective referral strategy for AAU patients is needed to shorten the diagnostic delay of SpA and enable an early effective treatment. Further, the risk for ophthalmological manifestations increases with the disease duration in SpA; and patients presenting with ocular symptoms should be referred to an ophthalmologist. Thus, a close collaboration between patient, rheumatologist and ophthalmologist is needed to optimally manage ocular inflammation in SpA.