Introduced in 2004, the UK’s Quality and Outcomes Framework (QOF) is the world’s largest primary care pay-for-performance program. Given some evidence of mortality benefit and substantial costs, it remained unclear whether the program is cost-effective.
Pandya and colleagues developed a simulation model to project the changes in quality-adjusted life expectancy and costs for a UK population cohort of 27 million individuals exposed to the QOF and to a counterfactual scenario without the QOF. The model-based results suggest that continuing the QOF in its current form is not cost-effective compared to stopping the program and returning all associated incentive payments to the National Health Service.
The authors conclude that the UK should redesign the QOF or pursue alternative interventions to efficiently improve population health.