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Cost saving guidance

In recognition of the challenging financial situation that the NHS is facing we have reviewed the national cost estimates we have made and the list below summarises that which we consider deliver savings. The national estimated saving could run to millions, however, this is across a variety of settings and in some cases may free up resources and capacity that can be used for other services, rather than delivering cash savings. For example, reductions in admissions need to reach a critical mass before it is possible to reduce inpatient facilities; although, of course, any capacity freed up will help deal with increasing demand without having to deploy additional resources, so represents an improvement in productivity.

This list is based on costing work undertaken at the time the guidance is published and covers all clinical guidelines from January 2005 and technology appraisals from January 2006. All guidance that was considered to deliver a net saving has been identified. There may be elements of other guidelines that will deliver savings, but in some circumstances, fully implementing the guidance requires investment. There are also other times when we know that guidance will improve patient care and deliver savings, but the data is not robust enough to allow us to quantify the level of savings. Our forward planner now includes a column that highlights non-quantifiable savings as well as showing the net cost or saving for each piece of guidance. We also produce NICE ´do not do´ recommendations to help the NHS reduce ineffective practice. For hints and tips on how organisations have tackled implementation of NICE guidance, including how they overcame any problems to do this, please refer to our Shared learning database of examples.

These figures are estimates only and not to be taken as the NICE view of desirable, maximum or minimum figures, but should be useful to provide a sense of the scale of savings achievable. We encourage users of the costing templates to modify the assumptions used in the templates to more accurately reflect local circumstances. The costing tools can be found at the bottom of each of the guidance pages.

Guidance Number Short title Why does this guidance save money? Estimated saving per 100,000 £
MTG3 CardioQ-ODM (oesophageal Doppler monitor) to guide intravenous fluid management in patients undergoing surgery, or in critical care Savings are expected to be made due to a reduction in hospital length of stay and postoperative complications due to better fluid management during surgery, using a less invasive monitoring method. -808,000
CG34 Hypertension (partial update of CG18) The recommendations update previous guidance on prescribing drugs for hypertension. Following the revised recommendations will cost more in drugs, but this is far outweighed by the predicted number of cardiovascular events (heart attacks and strokes) that will be avoided if hypertension is better controlled. See CG 127 below -446,627
CG30 Long-acting reversible contraception The recommendations relate to offering women seeking contraception an informed choice and access to long-acting reversible methods. These methods are more reliable than the oral contraceptive pill, where user-error often results in unplanned pregnancy. The additional cost of providing these methods is more than offset by the costs of unplanned pregnancies (reduced terminations or reduced births). -214,681
TA210 Vascular disease - clopidogrel and dipyridamole (review) Clopidogrel is now recommended for a larger group of people than in the previous guidance (TA90). There are likely to be some savings associated with a reduced price for clopidogrel since coming off patent. Savings are also expected as a result of an expected reduction in the number of events due to the reduced risk of an event for patients receiving clopidogrel rather than an alternative treatment. Initial prescribing is likely to be in secondary care, with primary care responsible for ongoing prescriptions. -129,000
TA211 Constipation (women) - prucalopride The prescribing of Prucalopride as a treatment for chronic constipation in women will potentially lead to a reduction in referrals to secondary care consultants and in the number of patients who require more invasive interventions or surgery . -74,734
MTG7 Inditherm Mattress for the prevention of inadvertent perioperative hypothermia Where warming is not currently used, use of the Inditherm mattress may generate savings due to reduced surgical site infections. -30,768
QS24 Nutrition support in adults Costs arising from this guideline included improving systematic screening, assessment and treatment of malnourished patients. If this was fully implemented and resulted in better nourished patients then this would lead to reduced complications such as secondary chest infections, pressure ulcers, wound abscesses and cardiac failure. Conservative estimates of reduced admissions and reduced length of stay for admitted patients, reduced demand for GP and outpatient appointments indicate significant savings are possible. -71,800
CG127 Hypertension (update) Following an initial investment in home blood pressure equipment monitoring ,in future years, as more people benefit from more accurate diagnoses using Ambulatory blood pressure monitoring, a cumulative effect of people not being on antihypertensive drugs starts to be seen. Savings from reduced treatment costs (because of not providing treatment for people who are not truly hypertensive) will start to outweigh the additional costs of diagnoses from year 3.
-20,464
CG108 Chronic heart failure (partial update) Implementing the recommendations are anticipated to result in greater costs for diagnosing and monitoring patients with CHF at an earlier stage, and increased costs for rehab. However this is more than offset by anticipated reductions in acute admissions in this patient group that have frequent readmissions. -19,000
CG115 Alcohol dependence and harmful alcohol use The guideline is one of three pieces of NICE guidance addressing alcohol-related problems and should be read in conjunction with PH24 and CG100. It is anticipated that implementing this guidance will lead to additional costs due to increasing the proportion of people with mild alcohol dependence receiving psychological interventions and increasing the number of people with moderate and severe dependence receiving medication to prevent relapse following successful withdrawal. These costs are likely to be offset by a reduction in the number of people who are dependent on alcohol, a reduction in the number of people who relapse following successful withdrawal and savings due to people being offered an intensive community programme , rather than residential rehabilitation. -18,600
CG107 Hypertensive disorders during pregnancy Increased costs for greater use of aspirin and monitoring of proteinuria are considered to be more than offset by reductions in adverse outcomes with increased costs for treating pre-eclampsia, pre-term deliveries and babies needed special care. -15,300
MTG2 MoorLDI2 Burns Imager a laser Doppler blood flow imager for the assessment of burn wounds Savings are expected to be made due to better diagnosis of burn wound depth and healing potential, and therefore better decisions made regarding those cases which require skin grafting. -12,296
TA152 Ischaemic heart disease - coronary artery stents (review) The recommendation is anticipated to lead to a reduction in the cost of drug eluting stents, as they are only considered cost effective where the additional cost of the drug-eluting stents over bare-metal stents is £300 or less. -10,294
CG81 Breast cancer (Advanced) One of the recommendations in this guidance recommended a change to current practice relating to patients receiving trastuzumab for advanced breast cancer. It is recommended that treatment is discontinued if the disease progresses outside of the central nervous system. It was considered that 50% of women taking trastuzumab and where the disease progresses outside of the central nervous system currently continue to take trastuzumab. In addition to quantified savings relating to trastuzumab we anticipate a reduction in hospital admissions as a result of improved treatment of patients with bone netastases. Bone metastases account for over a third of all nights in hospital in advanced breast cancer care. -9,690
CG75 Metastatic spinal cord compression Implementing the guidelines is anticipated to increase surgery for the prevention and treatment of MSCC at a cost of £14 million. This is more than offset by the reduced care costs for the increased periods that patients keep the ability to remain mobile. The cost difference per patient per day between those able to walk, and those that are immobile is £180, some of which is social care costs. Based on those patients expected to be discharged home and cared for in the community a national saving of £17.5 million was estimated. -8,974
CG69 Respiratory tract infection in Primary Care The use of a no prescribing, or delayed prescribing policy for a number of conditions (detailed in the guideline) is anticipated to lead to a reduction in antibiotic prescribing of £3.7 million nationally. Additionally there may be benefits, that it is not possible to quantify, arising from reduced use leading to less antibiotic resistance and reduced adverse events associated with antibiotic use. -7,299
CG33 Tuberculosis The majority of the savings arising from changes recommended in the BCG vaccination programme in children between 10-15 year old. In addition we anticipate reduced costs of treating active infection through better identification leading to reduced transmission. -7,239
CG40 Urinary incontinence We anticipated a reduction in the cost of urodynamic investigations that would be carried out before conservative treatment or surgery. -6,506
TA177 Eczema (chronic) - alitretinoin Alitretinoin is recommended as a treatment option for this condition for patients meeting the criteria set. Treatment can only be provided by a specialist. A move to alitretinoin may reduce the demand on dermatological services if there is a shift away from the PUVA treatment option. -5,962
CG58 Prostate cancer A number of recommendations relating to whether or not to biopsy, when to offer active surveillance and use of hormonal treatments are predicted to save money. These savings are offset by increased use of radical external beam radiotherapy. -5,396
TA230 Bivalirudin for the treatment of ST-segment elevation myocardial infarction Savings are assumed to arise from lower numbers of bleeds and because bivalirudin is lower cost compared with other treatments. -4,631
CG54 Urinary tract infection in children A change in the cost of urine collection is estimated to cost £2.9 million, which is offset by anticipated reduction in numbers of referrals and imaging procedures of £5.0 million. -4,210
TA223 Peripheral arterial disease - cilostazol, naftidrofyryl oxalate, pentoxifylline and inositol nicotinate A saving is expected due to a change in the prescribing pattern of vasoactive drugs. -3,488
CG80 Breast cancer (early) Recommendations relating to pre-treatment ultrasound evaluation of the axilla is considered to avoid additional surgery if nodal disease is identified before initial surgery. -2,698
MTG8 The VeriQ system for assessing graft flow during coronary artery bypass graft surgery The VeriQ system (MediStim ASA) uses ultrasonography for the non-invasive assessment of graft blood flow during coronary artery bypass surgery. The VeriQ system should improve the outcomes of revascularisation procedures by reducing the risk of early graft failure and adverse events. The VeriQ system may reduce hospital stay for some patients by reducing the incidence of complications during and after surgery. The additional cost of using the VeriQ system is expected to be more than offset by the savings made from reducing the number of repeat procedures and treatments for other post-operative complications. -2,643
CG99 Constipation in children and young people The recommendations are anticipated to increase prescribing costs, but lead to fewer outpatient attendances and inpatient admissions. -2,020
CG64 Prophylaxis for Infective Endocarditis It is anticipated that a reduction in prophylactic antibiotic prescribing will lead to reduced expenditure. In addition to the quantified savings in antibiotics savings from reduced adverse effects of antibiotics such as anaphylaxis and antibiotic resistance will occur. -1,411
TA191 Gastric cancer (advanced) - capecitabine Although the drug cost for capecitabine is higher than for fluorouracil, the higher administration cost for intravenous administration rather than oral administration means that the overall treatment cost for capecitabine is lower. -1,000
CG60 Surgical management
of OME
The recommendations are anticipated to result in a reduction of adenoidectomies and in antibiotic prescribing for OME. -776
TA184 Lung cancer (small-cell, second line treatment) - topotecan Only a small number of patients are estimated to switch from IV chemotherapy to oral topotecan, with a few patients not considered fit for IV chemotherapy predicted to be suitable for oral topotecan. -748
CG100 Alcohol use disorders - physical complications Implementing the guidance is anticipated to require investment in alcohol specialist professionals (£5.9 million) and an increase in assessment and surgery for chronic alcohol related pancreatitis (£1 million). However, this is more than offset by an anticipated reduction due to symptom-triggered drug treatment for withdrawal (saving £7.1 million) assess locally
CG37 Postnatal care The annual costs have been found to vary from an initial cost of £6.8 million to a potential saving of £1.1 million, due to the effect of increasing savings and reducing training costs over time. The savings arise from a reduction in the incidence of childhood disease due to the protective effects of breastfeeding assuming following the recommendations will lead to an increase in the numbers of mothers who breastfeed. (see also PH11 Public health guidance on maternal and child nutrition) per average unit experiencing 2534 births p.a. net savings range £5000-£9000

This page was last updated: 13 August 2013

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.