NICE costing templates estimate the financial cost and the health benefits of implementing guidance. This work investigated the possibility of producing a summary of the findings generated by public health NICE costing templates at a regional level and whether it is possible to update templates which use old population data and costs. Region wide summaries were produced for 5 NICE public health guidelines and a guide to updating the costing templates was produced.
East Midlands Public Health Observatory
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
NICE produce implementation aids to their guidance documents; for some of the guidelines these aids include costing templates. These templates estimate the financial cost and the health benefits of implementing the guidance. They estimate for fully implementing the NICE guidance: - The cost of treating people identified as a result of NICE guidance. - In some cases the impact in terms of health events avoided. The templates use findings from research or when these are not available expert opinion to make assumptions about the epidemiology of disease and the impact of treatment. Assumptions about current practice and implications of changing this to reflect the NICE guidance are also factored into the costings which are based on national tariffs or drug costs (correct at the time of publication). These assumptions are applied to the most recent population data available at the time the templates are produced. The aim of this work was to investigate the possibility of producing summaries of the costing templates for public health NICE guidelines at a regional level and whether it is possible to update the population data and costing assumptions in templates which use old population data and costs. There were several main objectives to the work: - To produce regional summaries of some of the key public health costing templates to aid local implementation of the guidance and to highlight the benefit of implementing the guidance locally. - To investigate if costing templates can be easily updated with new information. As some of the costing templates relate to guidance which is several years old, one of the objectives of this work is to ascertain whether the costing templates can be updated to reflect changes in health geographies and costs. - To publicise the benefits of using the costing templates by raising awareness within the region, by informing the regional Directors of Public Health group and including a costing template section on the East Midlands Public Health Observatory website.
Feedback from the regional Directors of Public Health group and another regional Public Health Observatory suggested that the costing templates could be used more widely at a local level. Where they have been used they have been useful for business planning and are a good tool for working with commissioning teams. When used, the templates were populated locally, meaning that for the East Midlands region, if all PCTs populated separately then nine separate organisations needed to understand, access and summarise the costing template. This initiative investigated whether this could be performed more efficiently once for the whole region. It was also thought that the benefits of implementing the guidance would be better understood if the number of health events which are avoided by the implementation of the guidance were highlighted. The templates which included measures of health benefit were therefore prioritised for regional summary. In some cases public health guidance has not been fully implemented within the region (even if the guidance was several years old). Some of the costing templates used primary care organisation geographies and population estimates which were current at the time of production but are now outdated. Furthermore the costs which were used are based on price at the time of development. Methods of easily updating both the population data and the costs were investigated.
The costing templates are in the form of excel spreadsheets and are relatively easy to populate. The PCT populations from the time that the costing template was developed can be accessed within the tool, or more recent population denominators can be self inputted. For this work the selected public health templates (based on whether health benefits were included) were updated to reflect the most recent population estimates and health geographies. Although this is a simple process it is time consuming as each locality population needs to be applied individually to the costing templates. As some of the costing templates were produced several years ago, there may have been changes to the cost estimates used in the original templates. Following investigation of the costing methods it was not thought to be possible to update each of the separate costs described in each template. A more practical method of reflecting current costs is to apply a proportionate inflationary uplift to the final costs for each year that has passed since the development of the templates. An uplift figure based on national NHS net pay and price uplift figures may be applied.
The work resulted in three separate outcomes: 1. Several regional summaries of the cost and the benefits included in a selection of public health templates were produced. The costing templates were updated with the most recent population data (at the time of writing) at PCT and when appropriate local authority level. The year that the templates were developed has been noted and the proportionate increase in costs that could be expected was indicated so that local teams can apply this uplift to the findings. The guidelines which were summarised are listed below: - PH1: Brief interventions and referral for smoking - PH2: Four commonly used methods to increase physical activity - PH4: Interventions to reduce substance misuse among vulnerable young people - PH25: Prevention of cardiovascular disease - CG48: Myocardial infarct (MI) secondary prevention - TA 160 and TA 161: Osteoporosis: primary and secondary prevention (single template for both appraisals) 2. As it was too time-consuming to produce regional summaries of all the public health costing templates, a list of current public health guidelines which have an accompanying costing template has been produced. This will be updated 2-3 times a year to allow easy reference to the PH costing templates which are available and will act as a method of publicising what is available. 3. A costing template guide was produced. This outlines how to use the templates, where to find the information to update the population data and a practical method of updating the costing assumptions. This document will aid local teams to make the best use of existing costing templates
It is relatively time-consuming to update the costing templates to produce regional summaries of the findings. The issues which were identified during this investigatory work have been shared with the NICE team that produces costing templates. This has resulted in the Costing Team considering a future pilot of a costing template which will be easier to populate for multiple areas e.g. a region. For local teams, the 'how to update NICE costing templates document' allows a consistent approach to updating local population and costing assumptions. This will be a useful aid in costing templates which do not include the most recent data available. The findings from this work and all supporting material can be found on the EMPHO website at the address. URL: http://www.empho.org.uk/methodologies/costingtemplates/costingtemplates.aspx
Public Health Analyst
East Midlands Public Health Observatory
Is the example industry-sponsored in any way?