Health Economics Scenario Lab
PathShift
Explore how pathway redesign might change activity, admissions, follow-up burden, bed use, and value under different assumptions.
Scope and use note
PathShift is an exploratory scenario sandbox. It is designed to test how pathway redesign, lower-cost setting shift, reduced admissions, and reduced follow-up burden might influence operational and economic value. It does not replace formal evaluation, forecasting, or business case development.
Signal
Appears cost-effective
Discounted net cost
£30,514
Cost/QALY
£1,448
Headline view
Start with the current decision signal and the main economic outputs.
Patients shifted
543
Admissions avoided
65
Discounted net cost
£30,514
Discounted cost per QALY
£1,448
Return on spend
0.96x
Break-even cost per patient
£321
Required redesign effect
9.7%
Current case type
Follow-up reduction case
What this suggests
PathShift suggests the redesign delivers measurable pathway and outcome benefit and appears cost-effective over 3 years, although it does not appear cost-saving. The result looks promising, but still assumption-dependent.
Main dependency
follow-up reduction
Main fragility
The result may depend on whether broad implementation is diluting value that would look stronger in a narrower higher-opportunity subgroup.
Charts
Primary chart first, with supporting views below.
Patients shifted in pathway
Annual pathway shift across the selected horizon.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Share of the pathway effectively reached.
Targeting approach
These assumptions replace named targeting modes and let you specify how concentrated the opportunity is in your use case.
Share of the full pathway population considered genuinely targetable.
Adjustment applied to the headline implementation reach assumption.
Adjustment applied to baseline admission risk in the targeted subgroup.
Redesign effects
These are the main levers shaping where value comes from.
Core pathway substitution effect.
Relative reduction in admissions.
Reduction in follow-up burden.
Reduction in inpatient stay.
Analysis
Review the current case, uncertainty, sensitivity, and practical next checks.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
Over 3 years, PathShift suggests the redesign creates meaningful pathway and outcome benefit, with around 543 patients shifted and 65 admissions avoided. It does not appear cost-saving, but it does sit within the current threshold on a discounted basis. The current case uses admission and follow-up savings only. The result is most strongly shaped by follow-up reduction. The case looks fragile: some bounded cases are below threshold, while others are not.
Current case type
Follow-up reduction case
Return on spend
0.96x
Break-even horizon
1 year
Recommendation summary
What this suggests
PathShift suggests the redesign delivers measurable pathway and outcome benefit and appears cost-effective over 3 years, although it does not appear cost-saving. The result looks promising, but still assumption-dependent.
What is driving it
follow-up reduction
What looks fragile
The result may depend on whether broad implementation is diluting value that would look stronger in a narrower higher-opportunity subgroup.
Validate next
Test whether a more targeted redesign improves value without losing too much pathway impact.
Uncertainty readout
Low
£26,972
430 patients shifted · Above current threshold
Base
£1,448
543 patients shifted · Appears cost-effective
High
-£9,985
658 patients shifted · Appears cost-saving
Top sensitivity drivers
Driver 1
Redesign cost per patient
Largest ICER swing: £8,070
Driver 2
Proportion shifted to lower-cost setting
Largest ICER swing: £4,737
Driver 3
Current admission rate
Largest ICER swing: £2,280
Sensitivity interpretation
Takeaway 1
The result is most sensitive to redesign cost per patient and proportion shifted to lower-cost setting.
Takeaway 2
In practical terms, the case is strongest when redesign cost per patient, proportion shifted to lower-cost setting, and current admission rate remain favourable under locally credible assumptions.
Takeaway 3
The case weakens fastest when redesign effects are smaller than expected, implementation becomes more expensive, or downstream pathway benefits are less pronounced locally.
Confidence summary
3 high-confidence, 15 medium-confidence, and 8 low-confidence assumptions are currently in play.
Headline view
Start with the current decision signal and the main economic outputs.
Patients shifted
543
Admissions avoided
65
Discounted net cost
£30,514
Discounted cost per QALY
£1,448
Return on spend
0.96x
Break-even cost per patient
£321
Required redesign effect
9.7%
Current case type
Follow-up reduction case
What this suggests
PathShift suggests the redesign delivers measurable pathway and outcome benefit and appears cost-effective over 3 years, although it does not appear cost-saving. The result looks promising, but still assumption-dependent.
Main dependency
follow-up reduction
Main fragility
The result may depend on whether broad implementation is diluting value that would look stronger in a narrower higher-opportunity subgroup.
Charts
Primary chart first, with supporting views below.
Patients shifted in pathway
Annual pathway shift across the selected horizon.
Cost vs savings
Cumulative delivery cost compared with gross savings.
Pathway impact
Headline operational impact over the selected horizon.
Bounded uncertainty
Low, base, and high cases against the current threshold.
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Assumptions
Start from the default case, then adjust the key inputs and advanced settings.
Quick assumptions
Core setup
Share of the pathway effectively reached.
Targeting approach
These assumptions replace named targeting modes and let you specify how concentrated the opportunity is in your use case.
Share of the full pathway population considered genuinely targetable.
Adjustment applied to the headline implementation reach assumption.
Adjustment applied to baseline admission risk in the targeted subgroup.
Redesign effects
These are the main levers shaping where value comes from.
Core pathway substitution effect.
Relative reduction in admissions.
Reduction in follow-up burden.
Reduction in inpatient stay.
Advanced assumptions
Analysis
Review the current case, uncertainty, sensitivity, and validation prompts.
Report export
Export a structured summary of the current assumptions, results, and interpretation.
Strategic summary
Over 3 years, PathShift suggests the redesign creates meaningful pathway and outcome benefit, with around 543 patients shifted and 65 admissions avoided. It does not appear cost-saving, but it does sit within the current threshold on a discounted basis. The current case uses admission and follow-up savings only. The result is most strongly shaped by follow-up reduction. The case looks fragile: some bounded cases are below threshold, while others are not.
Current case type
Follow-up reduction case
Follow-ups avoided
1,810
Bed days avoided
652
Return on spend
0.96x
Recommendation summary
What this suggests
PathShift suggests the redesign delivers measurable pathway and outcome benefit and appears cost-effective over 3 years, although it does not appear cost-saving. The result looks promising, but still assumption-dependent.
What is driving it
follow-up reduction
What looks fragile
The result may depend on whether broad implementation is diluting value that would look stronger in a narrower higher-opportunity subgroup.
Validate next
Test whether a more targeted redesign improves value without losing too much pathway impact.
Uncertainty readout
Low
£26,972
430 patients shifted · Above current threshold
Base
£1,448
543 patients shifted · Appears cost-effective
High
-£9,985
658 patients shifted · Appears cost-saving
Sensitivity
One-way sensitivity
Top drivers of discounted cost per QALY when varied one at a time.
Driver 1
Redesign cost per patient
Largest ICER swing: £8,070
Driver 2
Proportion shifted to lower-cost setting
Largest ICER swing: £4,737
Driver 3
Current admission rate
Largest ICER swing: £2,280
Sensitivity interpretation
Takeaway 1
The result is most sensitive to redesign cost per patient and proportion shifted to lower-cost setting.
Takeaway 2
In practical terms, the case is strongest when redesign cost per patient, proportion shifted to lower-cost setting, and current admission rate remain favourable under locally credible assumptions.
Takeaway 3
The case weakens fastest when redesign effects are smaller than expected, implementation becomes more expensive, or downstream pathway benefits are less pronounced locally.
Decision readout
Current case type
Follow-up reduction case
Uncertainty readout
The case looks fragile: some bounded cases are below threshold, while others are not.
Interpretation summary
PathShift suggests the redesign delivers measurable pathway and outcome benefit and appears cost-effective over 3 years, although it does not appear cost-saving. The result looks promising, but still assumption-dependent.
Confidence summary
3 high-confidence, 15 medium-confidence, and 8 low-confidence assumptions are currently in play.
Assumption review
Annual cohort size
2,000
Operational estimate · Medium confidence
Current acute-managed rate
40.0%
Operational estimate · Medium confidence
Current admission rate
18.0%
Operational estimate · Medium confidence
Current follow-up contacts per patient
2.5
Operational estimate · Medium confidence
Current average length of stay
5.0
Operational estimate · Medium confidence
Implementation reach rate
70.0%
Operational estimate · Medium confidence
Target population multiplier
1.00x
User override · Medium confidence
Target reach multiplier
1.00x
User override · Medium confidence
Target admission risk multiplier
1.00x
User override · Medium confidence
Proportion shifted to lower-cost setting
15.0%
Illustrative default · Low confidence
Reduction in admission rate
10.0%
Illustrative default · Low confidence
Reduction in follow-up contacts
20.0%
Illustrative default · Low confidence
Reduction in length of stay
10.0%
Illustrative default · Low confidence
Redesign cost per patient
£220
Operational estimate · Medium confidence
Annual effect decay
10.0%
Illustrative default · Low confidence
Annual participation / implementation drop-off
5.0%
Illustrative default · Low confidence
Cost per acute-managed patient
£1,200
Operational estimate · Medium confidence
Cost per community-managed patient
£500
Operational estimate · Medium confidence
Cost per follow-up contact
£120
Operational estimate · Medium confidence
Cost per admission
£3,800
Operational estimate · Medium confidence
Cost per bed day
£400
Illustrative default · Low confidence
Costing method
Admission and follow-up savings only
User override · Medium confidence
QALY gain per patient meaningfully improved
0.04
Evidence-informed proxy · Low confidence
Time horizon
3
User override · High confidence
Discount rate
3.5%
Evidence-informed proxy · High confidence
Cost-effectiveness threshold
£20,000
Illustrative default · High confidence