NICE impact mental health

This report from NICE considers how evidence-based guidance can contribute to improvements in the care of people with mental health conditions. The report reviews how NICE recommendations for cost-effective care are being used in priority areas of the health and care system.  Click here to read further.

NIHR Signal Hospital admission rates and costs increase in line with BMI

NIHR Signal Hospital admission rates and costs increase in line with BMI


Each 2kg/m² rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group. 


Published on 20 March 2018 
Full document available at: https://discover.dc.nihr.ac.uk/portal/article/4000975/hospital-admission-rates-and-costs-increase-in-line-with-bmi

Ceritinib for untreated ALK-positive non-small-cell lung cancer [TA 500]

New:  Technology appraisal guidance


Ceritinib is recommended, within its marketing authorisation, as an option for untreated anaplastic lymphoma kinase (ALK)‑positive advanced non-small-cell lung cancer in adults, only if the company provides it with the discount agreed in the patient access scheme.




Why the committee made this recommendation
Most people with untreated ALK‑positive advanced non-small-cell lung cancer are offered crizotinib. Chemotherapy may be offered if the person's ALK mutation status isn't known, and therefore is not a relevant comparator for ceritinib. There are no trials directly comparing ceritinib with crizotinib; the clinical trial compares ceritinib with chemotherapy.


Because the clinical trial has not finished, it is unable to show how much ceritinib prolongs life compared with chemotherapy. But it shows that ceritinib is more effective than chemotherapy at increasing the length of time people live without their disease progressing. An indirect comparison suggests that ceritinib is more effective than crizotinib. Clinical experts support using ceritinib instead of crizotinib.

Glecaprevir–pibrentasvir for treating chronic hepatitis C [TA 499]

New:  Technology appraisal guidance


Glecaprevir–pibrentasvir is recommended, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.


It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need.




Why the committee made these recommendations
  
Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir–pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments.

Golimumab for treating non-radiographic axial spondyloarthritis [TA 297]

New: Technology appraisal guidance


Golimumab is recommended, within its marketing authorisation, as an option for treating severe non-radiographic axial spondyloarthritis in adults whose disease has responded inadequately to, or who cannot tolerate, nonsteroidal anti-inflammatory drugs.


If patients and their clinicians consider golimumab to be one of a range of suitable treatments, including adalimumab, etanercept and certolizumab pegol, the least expensive (taking into account administration costs and patient access schemes) should be chosen.




Assess the response to golimumab 12 weeks after the start of treatment. Continue treatment only if there is clear evidence of response, defined as:

• a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and
• a reduction in the spinal pain visual analogue scale (VAS) score by 2 cm or more.

Plasma EGFR mutation tests for adults with locally advanced or metastatic non-small-cell lung cancer [MIB 137}

New:  Medtech innovation briefing


Epidermal growth factor receptor (EGFR) mutation tests are in vitro diagnostic (IVD) tests used to help identify adults with non-small-cell lung cancer (NSCLC) suitable for treatment with EGFR tyrosine kinase inhibitors (EGFR‑TKIs). The presence of specific EGFR mutations show how effective treatment with EGFR‑TKIs will be. As a result, the test is useful for oncologists for deciding personalised treatment options.


EGFR mutations occur in EGFR exons 18–21 and mutations in exons 18, 19 and 21 and indicate suitability for treatment with EGFR‑TKIs. Mutations in exon 20 (with the exception of a few mutations) show the tumours are EGFR‑TKI resistant and not suitable for treatment with EGFR‑TKIs.

Mental health problems at work cost UK economy £34.9bn last year, says Centre for Mental Health

Mental health problems in the UK workforce cost employers almost £35 billion last year, according to research published today by Centre for Mental Health. See research here

2016/17 reference cost data

Reference costs are the average unit cost to the NHS of providing defined services to NHS patients in England in a given financial year. They show how NHS providers spend money to provide healthcare to patients.

The 2016/17 reference cost data is presented in four ways:

• the national schedules of reference costs 
• the reference cost index 
• the reconciliation statement 
• a database of source data

NIHR Signal Long-term antibiotics likely to reduce risk of recurrent cellulitis

Antibiotics may reduce the risk of leg cellulitis by about two thirds, in adults who have had at least two previous episodes, but only while they take the antibiotics. There is limited evidence measuring the efficacy of other forms of prevention
.
A review of five studies showed that the risk of developing repeated cellulitis was reduced in participants who were taking long-term (more than six months) penicillin or erythromycin, compared with a control group. Once the antibiotic course had finished, participants’ risk of recurrent cellulitis was no different from the control group.


Cellulitis is a bacterial skin infection that spreads and worsens quickly. Risk of recurrence is high in people with a predisposing condition such as poor leg circulation.


This review explored the effectiveness of various preventative interventions for recurrent cellulitis. It highlights the need to explore non-pharmacological options, such as compression stockings, moisturisers or exercise. These could be cheaper and avoid the risk of increasing antibiotic resistance, but few studies of these options were identified.


From the NIHR Dissemination Centre

NIHR Signal Individual support of nurses using electronic medicine monitors can improve HIV treatment

Use of electronic pill bottles that record when they are opened and follow-up discussion of the printed readouts with nurses improved HIV outcomes. It is thought that patients became more reliable in taking the medication, which can have complicated scheduling. Overall, the HIV virus in the blood and the risk of treatment failure were lower in the group of patients who had access to this intervention compared to regular care.


In addition to being more effective, the programme also reduced the estimated lifetime cost and disease burden per patient, considering quality and quantity of life lived.


The readouts were used to help focus attention on any patterns of medication usage so that strategies could be discussed to improve adherence. As non-adherence is the main barrier to effective management of HIV, any measures that improve it are welcomed. However, the intervention tested here requires several hours of training for the nurses delivering it and may not be that easy to introduce in practice. Evaluation of the approach in non-trial settings is necessary before wider implementation.

NIHR Signal Early discharge ‘hospital-at-home’ gives similar outcomes to in-patient care

Supported early discharge, where patients receive on-going hospital-level treatment in their own home, had no effect on mortality compared with standard in-patient care. Patients had shorter hospital stays, were more likely to be satisfied and less likely to end up in residential care.


This updated Cochrane review identified 32 international trials comparing early discharge hospital-at-home with hospital in-patient care. Most evidence related to people recovering from a stroke, where NICE already recommends supported discharge if this is appropriate. Other patient groups included those recovering from orthopaedic surgery and older people with various conditions. Trials were relatively small and the overall evidence quality was moderate to low.


The review aimed to see whether early discharge has an effect on NHS costs, but found insufficient evidence. Training, staffing and equipment costs need to be measured against patient outcomes in different therapy areas. Early supported discharge needs to be driven in areas where it can make the most difference and give the greatest benefit.


From NIHR Dissemination Centre

Approved costing guidance

Updated 4th October

The Approved costing guidance forms a co-ordinated approach to patient-level costing (PLICS), the reference costs collection and the reference costs assurance programme.  It has recently been updated.

It comprises:

• costing standards to be used by providers of NHS services 
• PLICS collection guidance to be used by acute sector early implementers in submitting their 2016/17 cost data
• integrated reference costs and education and training collection guidance to be used for submitting 2016/17 cost data, which are mandatory for all providers of NHS services

Costing newsletter: September 2017

Latest news from NHS Improvement's costing transformation programme. In this edition

• news about cost collections in 2018 - a big step towards a single national cost collection
• the national PLICS portal is ready to launch
• call for volunteers to review the 2018 acute standards and collection guidance
• your chance to have a say on mandating patient-level costing
• your opportunity to be a 2018 'early implementer'

NHS efficiency map

Healthcare Financial Management Association -
This map promotes best practice in identifying, delivering and monitoring cost improvement programmes in the NHS. It contains links to a range of tools and guidance to help NHS bodies improve their efficiency. The map is split into three sections: enablers for efficiency, provider efficiency and system efficiency. It highlights the successes some NHS providers have had in delivering specific efficiency schemes and provides sign-posts to existing tools and reference materials. It also includes updated definitions for different types of efficiency.

Introducing the GAPI project

The Group Advising on Pricing Improvement (GAPI) programme allows clinicians to put a ‘reasonable test’ against the cost of commonly performed orthopaedic procedures.

The pilot study will eventually involve 30 trusts and will be limited to seven orthopaedic procedures. As part of the programme, senior clinicians in the pilot trusts are being asked to review the reported PLICS costs for their trust and provide feedback.

For further details about the GAPI programme please contact pricing@improvement.nhs.uk 

The cost of sepsis care

The Sepsis Trust has published its report on the cost of sepsis care in the UK.

Transforming patient-level costing in the NHS

NHS Improvement is due to publish the next version of the Healthcare Costing Standards and Cost Collection Guidance at the end of January. To support the publication we are running two webinars.

• Improving costing: the new Healthcare Costing Standards for England, Thursday 2 February 2017, 12:30pm – acute standardsopens in a new window
• Improving costing: the new Healthcare Costing Standards for England, Thursday 2 February 2017, 2pm – ambulance and mental health standards

NHS reference costs 2015 to 2016

This document provides the most up-to-date information about how NHS expenditure was used to provide health care by NHS trusts and NHS foundation trusts. Reference costs are the unit costs to the NHS for providing defined services in a given financial year to NHS patients in England.

NHS reference cost assurance programme: findings from the 2015/16 audit

Findings from an audit of the 2014/15 reference cost submissions of 79 acute NHS trusts and foundation trusts.

Patient-Level Information and Costing Systems (PLICSs): A Mixed-Methods Study of Current Practice and Future Potential for the NHS Health Economy

Traditionally, the cost object in health care has been either a service line (e.g. orthopaedics) or a clinical intervention (e.g. hip replacement). In the mid-2000s, the Department of Health recommended that in the future the patient should be the cost object, to enable a better analysis of cost drivers in health care, resulting in PLICSs. Monitor proposes that PLICS data will now form the basis for mandatory prices for health-care services across all care settings. This NIHR study aimed to explore the current use of PLICSs and the potential for future use of PLICSs in commissioning.