The health and social care system faces significant financial challenges. We've reviewed our cost estimates associated with implementing NICE guidance and identified where savings may be made. The table below identifies possible savings across a variety of settings. In some cases, resources and capacity could be used for other services. This would result in improved productivity rather than delivering actual cash savings.

This list includes guidance published from August 2012 onwards.

The figures are estimates only and aren't to be taken as our view of desirable, maximum or minimum figures. They provide a sense of the scale of achievable savings. You can change the assumptions used in our resource impact reports and templates 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.

Other guidance may deliver savings, but fully implementing the guidance may require investment.


Guidance Number Short title Why does this guidance save money? Estimated saving per 100,000 population (£)
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.

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.

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 and sigmoidoscopy in secondary care services. 20,000
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
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.

MTG30 XprEss multi sinus dilation system for treating chronic sinusitis

Guidance supports the use of XprESS multi-sinus dilation system for treating uncomplicated chronic sinusitis after medical treatment has failed. Resource impact work indicated there may be savings from reduced inpatient procedures, fewer revision operations being needed, and fewer readmissions following treatment with XprESS. The level of savings depends on how many XprESS procedures are done in an outpatient setting and the device cost of XprESS. Additional benefits include reducing the number of inpatient bed days needed, and increasing day-case and operating theatre capacity.

There is currently no national tariff for providing XprESS in an outpatient setting. Commissioners are encouraged to work with provider organisations to develop a local tariff.

DG23 PIGF-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
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
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
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
CG65 Hypothermia: prevention and management in adults having surgery

Implementing the guideline may result in the following benefits and savings:

  • fewer patients becoming hypothermic during surgery
  • a better experience of care for patients
  • a reduction in costs from adverse events caused by hypothermia.

Overall, the guideline update is expected to be cost saving.

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
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.

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).

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.

MTG33 ENDURALIFE powered CRT-D devices for treating heart failure

ENDURALIFE-powered CRT-D devices are expected to be cost saving because they have a long battery life. This means that fewer replacement devices are needed, which reduces exposing patients to an unnecessarily higher risk of complications associated with these replacement procedures.

Assess locally
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
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
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 MAGEC system has a payback period of less than 3 years. Anticipated savings per child after 6 years are estimated to be around £12,000. Assess locally