In recognition of the challenging financial situation faced by he health and social care system, we have reviewed our national cost estimates. The list below summarises where we consider savings to be possible. 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 any additional capacity will help deal with increasing demand without having to deploy additional resources. This would represent an improvement in productivity.
This list is based on costing work undertaken at the time guidance was published and identifies all guidance that was considered to deliver a net saving - including clinical guidelines from January 2005, all technology appraisals from January 2006, all medical & diagnostic technologies and all public health & social care guidance.
There may be elements of other guidelines that will deliver savings, but fully implementing the guidance may require investment. There are also other occasions when 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 resource planner 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
These figures are estimates only and are not to be taken as NICE's view of desirable, maximum or minimum figures. They should be useful in providing a sense of the scale of achievable savings. We encourage users of our resource impact reports and templates to modify the assumptions to more accurately reflect local circumstances.
Resource impact reports and templates are accessible through the tools and resources tabs on individual guidance and standards pages.
|Guidance Number||Short title||Why does this guidance save money?||Estimated saving per 100,000 (£)||Impact level|
|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||High|
|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).||-215,000||High|
|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||High|
|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 .||-74,700||High|
|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||High|
|CG95||Chest pain of recent onset: assessment and diagnosis||
The annual saving for commissioners associated with implementing this guideline update is anticipated to be around £17m for England from year 5 onwards. This is equivalent to around £31,500 per 100,000 population.
Savings are anticipated as a result of a shift in diagnostic imaging. An increase in the number of people receiving CT coronary angiography leads to savings from reduced numbers of people receiving invasive coronary angiography and other diagnostic tests.
|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.||-30,800||Medium|
|TA369||Ciclosporin for treating dry eye disease that has not improved despite treatment with artificial tears||The guidance recommends ciclosporin as an option for treating severe keratitis in adult patients with dry eye disease that has not improved despite treatment with tear substitutes. Ciclosporin is estimated to be suitable for around 43,000 people. The resource impact assessment indicates that there will be a saving from implementing the guidance due to decreased drug costs and the large eligible population. Savings of around £24,000 per 100,000 population are expected from 2020/21 onwards. Savings will be less in earlier years due to lower initial uptake of the technology.||-24,400||Low|
|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.||-20,500||Low|
|DG11||Faecal calprotectin diagnostic tests to differentiate inflammatory bowel disease from irritable bowel syndrome||It is anticipated that there may be a cost saving from avoiding referrals to secondary care. This may give a reduction in capacity requirements and waiting times for endoscopy/colonoscopy/sigmoidoscopy in secondary care services.||-20,000||Low|
|CG108||Chronic heart failure (partial update)||Implementing the recommendations are anticiapted 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||Low|
|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||Low|
|MTG28||Spectra Optia for automated red blood cell exchange in patients with sickle cell disease||Savings for commissioners are expected due to the reduced number of people requiring chelation therapy.||-18,100||Low|
|MTG32||HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography||
Resource impact work indicates there may be a significant national saving from the avoidance of unnecessary invasive coronary angiography (ICA) and percutaneous coronary interventions (PCI).
The availability of 64-slice CT coronary angiography may be a barrier to realising the savings in full. There is currently no national tariff for HeartFlow FFRCT and uncertainties around funding flows for provider organisations may be a barrier to implementation of the technology. Commissioners are encouraged to work with provider organisations to develop a local tariff to establish the use of HeartFlow FFRCT in interventional cardiology service provision.
|NG23||Menopause: diagnosis and management||The recommendations should result in a decrease in the number of follicle-stimulating hormone tests being received by women aged 45 years or older and because of this a saving of £9.6 million for England is expected. Some additional costs may result if women change from using oral to transdermal hormone replacement therapy. These costs are estimated as £0.9 million, resulting in an overall saving of around £8.7 million for England.||-16,500||Low|
|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||Low|
Guidance supports the use of
There is currently no national tariff for providing
|DG23||PlGF-based testing to help diagnose suspected pre-eclampsia||Implementation of the guideline may lead to a reduction in bed days and may increase available clinical time. Current estimates indicate that national savings of around £7.3 million may be possible in year 5. The savings are not anticipated to be cash releasing.||-13,500||Low|
|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.||-12,300||Low|
|NG2||Bladder cancer: diagnosis and management||Savings could arise from a reduction in the number of people with low risk non-muscle-invasive bladder cancer receiving follow-up cytoscopies in secondary care after 12 months. There could be increased drug costs of giving people suspected of low or intermediate risk non-muscle invasive bladder cancer a single dose of intravesical mitomycin C given at the same time as TURBT.||-11,500||Low|
|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 the additional cost of the drug-eluting stents over bare-metal stents is £300 or less.||-10,300||Low|
|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.||-9,700||Low|
|TA294||Macular degeneration (wet age-related) - aflibercept (1st line) [ID519]||Aflibercept is associated with fewer treatment and monitoring visits, implementing this guidance is likely to release resources to the NHS. Fewer visits will also reduce the burden on people with wet AMD and their carers in terms of time off work and travel costs.||-9,600||Low|
|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.||-9,000||Low|
|DG4||Adjunctive colposcopy technologies for examination of the uterine cervix - DySIS and Niris Imaging System||Use of Dysis may reduce the number of repeat tests and follow up appointments due to higher sensitivity than conventional colposcopy. It is anticipated there may be fewer diagnostic biopsies required, giving pathology test savings, however the improved sensitivity may lead to an increase in treatment biopsies. Future years savings may be achieved through avoiding progression to surgical interventions. Use of Dysis will incur capital costs with some on-going maintenance costs.||-8,000||Low|
|CG65||Hypothermia: prevention and management in adults having surgery||
Implementing the guideline may result in the following benefits and savings:
Overall, the guideline update is expected to be cost saving.
|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. Additionaly 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.||-7,300||Low|
|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.||-7,200||Low|
|CG40||Urinary incontinence||We anticipated a reduction in the cost of urodynamic investigations that would be carried out before conservative treatment or surgery.||-6,500||Low|
|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
|MTG12||EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing||The expected annual savings and resources released from using EXOGEN 4000+ per 100,000 population aged 18 years and over is around £5,700. This arises from reduced need for surgical intervention and the associated hospital resource use.||-5,700||Low|
|CG58||Prostate cancer||A number of recommendations relating to whether or not to biopsy, when to offer active surveillence and use of hormonal treatments are predicted to save money. These savings are offset by increased use of radical external beam radiotherapy.||-5,400||Low|
|DG5||SonoVue (sulphur hexafluoride microbubbles) - contrast agent for contrast enhanced ultrasound in liver imaging||Savings are anticipated due to a reduced number of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging scans as a result of providing increased numbers of contrast-enhanced ultrasound (CEUS) scans using SonoVue. Savings are also expected due to a reduction in the number of specialist assessments due to increased use of CEUS. Some additional training costs are anticipated due to the current shortage of appropriately trained sonographers able to complete CEUS.||-5,100||Low|
|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.||-4,600||Low|
|MTG15||Vision Amniotic Leak Detector (ALD) to eliminate amniotic fluid leakage as a cause of vaginal wetness in pregnancy||Using the Vision ALD could potentially save between £15 and £24 per women depending on the clinical scenario used. This is mainly a productivity saving resulting from reduced staff time required for administering Vision ALD compared to a speculum test.||-4,600||Low|
|MTG29||GreenLight XPS for treating benign prostatic hyperplasia||
The Medical Technology guidance document gives details of when the case for adopting GreenLight XPS 180 W for treating benign prostatic hyperplasia is supported. Resource impact work indicates that savings will be possible as a result of implementing the guidance.
Savings range from £1.3 million when 36% of procedures with GreenLight XPS are done as day cases, to as much as £3.2 million when 70% are done as day cases. Based on 53% of GreenLight XPS procedures being done as day cases, the guidance is estimated to save the NHS around £2.3 million per year (or £4,200 per 100,000 people).
|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.||-4,200||Low|
|TA223||Peripheral arterial disease - cilostazol,
||A saving is expected due to a change in the prescribing pattern of vasoactive drugs.||-3,500||Low|
|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.||-2,700||Low|
|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.||-2,600||Low|
|CG99||Constipation in children and young people||The recommendations are anticipated to increase prescribing costs, but lead to fewer outpatient attendances and inpatient admissions.||-2,000||Low|
|MTG9||PleurX peritoneal catheter drainage system for vacuum assisted drainage of treatment-resistant recurrent malignant ascites||The device allows repeated drainage of ascitic fluid in the community setting therefore reducing the need for repeated hospital visits and inpatient admissions.||-1,800||Low|
|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.||-1,400||Low|
|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||Low|
|The recommendations are anticipated to result in a reduction of adenoidectomies and in antibiotic prescribing for OME.||-780||Low|
|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.||-750||Low|
|DG25||High-throughput non-invasive prenatal testing for fetal RHD genotype||
"Resource impact work indicates there may be some savings from offsetting the test cost with avoided unnecessary treatment with anti-D immunoglobulin.
Additional benefits include conserving anti-D immunoglobulin stocks and reducing potential adverse events that can be associated with blood product use. Implementation of the guidance will result in savings to providers. "
|NG63||Antimicrobial stewardship: changing risk-related behaviours in the general population||Implementation of the guideline is anticipated to be cost saving with a reduction in the inappropriate prescribing of antimicrobials, an increase in the most appropriate use of antimicrobials, a corresponding reduction in the prevalence of antimicrobial resistance and reduced infections.||Assess locally||Assess locally|
|NG57||Physical health of people in prison||
"Implementing the recommendation on medicines reconciliation may generate savings for commissioners by reducing costs related to non-elective attendances and prison escort and bed watching. There may need to be some reallocation of resources within prison healthcare to implement this recommendation.
There are a number of recommendations in the guideline where it may be necessary to invest resources to support early interventions and planned management of conditions for people in prison. This investment may lead to savings from reducing emergency incidents and admissions, unplanned treatments, late presentation of conditions, and morbidity and mortality from infectious and communicable diseases."
|Assess locally||Assess locally|
|MTG18||The MAGEC system for spinal lengthening in children with scoliosis||The External Assessment Centre estimated the insertion costs of MAGEC rods to be £27,400, with an annual lengthening cost of £900. In contrast, conventional growth rods are estimated to cost £15,300 for insertion and £5400 for annual lengthening. The additional insertion cost of £12,100 for the
||Assess locally||Assess locally|
|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
||Assess locally||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||Assess locally|