Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic conditions affecting around 500,000 people in the UK and carries rising prevalence and substantial economic burden. Despite expanding therapeutic choice, contemporary UK cost analyses are scarce. A flexible cost of illness model was developed to estimate the excess costs associated with CDUC in the UK at a population level, including direct NHS costs and societal costs. The model estimates how the direct healthcare and indirect societal costs of IBD change over time, helping to analyse and manage key cost drivers. This supports planning and policy decisions by outlining how interventions and external influences affect long-term spending patterns. The study used public data, published research, and the 2023 IBD UK survey to create a cost model covering prevalence, diagnosis, management, complications, and mortality of CD and UC. Clinical management inputs included resource use associated with the ideal pathways in line with IBD Standards. This model estimated and compared healthcare use and complications in people with CD and UC to the general population over 15 years, including costs from flare-ups, remission, and societal impacts. The estimated total annual direct healthcare cost based on an optimal patient journey for CD and UC is £3 billion. Ongoing management makes up around 93

BackgroundThe existing intravenous systemic anticancer therapy (SACT) pathway in pharmacies is operationally inefficient. Manual, paper-based workflows render the system prone to human error, and the need for time-consuming manual verification diverts pharmacy staff time. The introduction of an automated workflow solution for the intravenous SACT pathway could optimize treatment timeliness and improve oncological outcomes for patients, aligning with the National Health Service Long Term Plan for improved cancer care. ObjectiveThis observational analysis aimed to assess the change in time, cost, and errors following the implementation of the Becton Dickinson (BD) Cato Pharmacy system in an aseptic unit producing intravenous SACT at Watford General Hospital. MethodsData on compounding process times were collected manually by pharmacy staff before and after the implementation of the intravenous compounding software (BD Cato). The data were analyzed to estimate annual time savings, opportunity cost savings, and error reduction. ResultsThe intravenous compounding software produced a time saving of 18 (SD 9) minutes per drug, equating to 1034 hours saved per year (1034/2591, 39.9% reduction). If this time were repurposed to producing more intravenous SACT, Watford General Hospital could increase production by 66% (2298/3482) annually (2298 additional intravenous SACT). This represents an average cost saving of £11.29 (£1=US $1.273) per drug, equating to an annual opportunity cost saving of £39,246. The intravenous compounding software also decreased observed errors by 86% (43/50), a reduction of 43 errors over 2 months (approximately 258 fewer errors annually). Staff also preferred the intravenous compounding software to the manual system. ConclusionsImplementing intravenous compounding software can save time, reduce costs, and lower errors in intravenous SACT preparation. This could improve timely treatment access for patients with cancer.

BACKGROUND:Bowel cancer screening in England is initially carried out using a home testing kit, with those who require further testing first being referred to an assessment clinic. During COVID-19, these assessment clinics became 'virtual' (telephone or video-call) where previously they had only been held face-to-face. METHODOLOGY:A before and after study design was constructed to examine the impact of this change in clinic type on key programme metrics. RESULTS AND CONCLUSIONS:The data showed fewer people changed their specialist screening practitioner appointments when the modality was virtual, with the virtual group also having higher clinic uptake and shorter times to first offered and first attended clinics.Despite clinical opinion that not being able to physically see a patient would negatively impact diagnostic test quality, suggesting that incomplete tests would rise, referrals to colonoscopy would fall, and bowel preparation quality would suffer, the data did not support any of these suppositions.Whilst the data indicated that diagnostic test uptake was lower in the virtual group, the presence of COVID-19 is likely to have skewed findings.The IT system is being developed to support virtual clinics, which will aid future data analysis/monitoring and assist staff with clinic management.

BACKGROUND:A virtual ward (VW) supports patients who would otherwise need hospitalization by providing acute care, remote monitoring, investigations, and treatment at home. By March 2024, the VW programme had treated 10 950 patients across six speciality VWs, including heart failure (HF). This evaluation presents the economic assessment of the Liverpool HF VW. METHOD AND RESULTS:A comprehensive economic cost comparison model was developed by the York Health Economics Consortium (University of York) to compare the costs of the VW to standard hospital inpatient care [standard care (SC)]. The model included direct VW costs and additional costs across the care pathway. Costs and resource use for 648 patients admitted to the HF VW were calculated for 30 days post-discharge and total cohort costs were extrapolated to a full year. Primary outcomes included costs related to length of stay, readmissions, and NHS 111 contact. The total cost for the HF VW pathway, including set-up costs, was £467 524. This results in an incremental net cost benefit of £735 512 compared with the total SC cost of £1 203 036, indicating a substantial net cost benefit of £1135 per patient per episode (PPPE). This advantage remains despite initial setup expenses and ongoing costs such as home visits, virtual consultations, point-of-care testing, and home monitoring equipment. CONCLUSION:Our HF VW model offers a substantial net cost benefit, driven by reduced hospital stays, fewer emergency department visits, and lower readmission rates. The study highlights the importance of considering system-wide impacts and continuous monitoring of VWs as they develop.

BACKGROUND:Supervised exercise therapy (SET) has been shown to improve claudication symptoms in patients with peripheral artery disease (PAD), and it is recommended as a first-line treatment in national and international guidelines. Despite this, supervised exercise programmes have not been widely implemented in many countries. This quality improvement project aimed to implement and evaluate an exercise service for people with claudication in York, England. METHODS:The York Claudication Exercise Service was launched in October 2023. Eligible patients were referred from vascular clinics at York Hospital. The service provided each participant with two, 1-hour exercise sessions per week over a 12-week programme. Standardised assessments were performed before and after the programme. Routinely assessed outcomes (e.g., recruitment, attendance, satisfaction, and treadmill walking distances) were used to evaluate the service over the first 12 months. Descriptive statistics were used to explore feasibility, acceptability, fidelity, and preliminary effects. A cost-comparison analysis was also conducted before and after the exercise service was implemented. RESULTS:By May 2024, 65 eligible patients had been referred, with 29 patients (44.6 %) commencing the exercise sessions. The exercise programme was delivered as intended and the median number of sessions attended was 19 (out of 24). At service exit, 13 (59.1 %) out of 22 participants reported an improvement in their claudication symptoms and were discharged to primary care. The mean (95 % CI) increase in pain-free walking distance was 110 m (39 to 182). All but one participant rated the service as 'good' or 'excellent'. Economic modelling estimated that the programme would result in an annual cost-saving of £223.21 per person, or £366.40 per person using estimated costs for a future delivery model. CONCLUSIONS:The service was successfully implemented within the existing care pathway. The evaluation indicated a high level of patient satisfaction, improvement in claudication symptoms and prevention of unnecessary referrals for vascular imaging and revascularisation. Agreements have been obtained to continue the service for at least 2 more years. During this period, sustainability funding will be sought, and the service will be adapted to improve access and uptake.

Aims: The direct cost of diabetes to the UK health system was estimated at around 10 pound billion in 2012. This analysis updates that estimate using more recent and accurate data sources. Methods: A pragmatic review of relevant data sources for UK nations was conducted, including population-level data sets and published literature, to generate estimates of costs separately for Type 1, Type 2 and gestational diabetes. A comprehensive cost framework, developed in collaboration with experts, was used to create a population-based cost of illness model. The key driver of the analysis was prevalence of diabetes and its complications. Estimates were made of the excess costs of diagnosis, treatment and diabetes-related complications compared with the general UK population. Estimates of the indirect costs of diabetes focused on productivity losses due to absenteeism and premature mortality. Results: The direct costs of diabetes in 2021/22 for the UK were estimated at 10.7 pound billion, of which just over 40% related to diagnosis and treatment, with the rest relating to the excess costs of complications. Indirect costs were estimated at 3.3 pound billion. Conclusions: Diabetes remains a considerable cost burden in the UK, and the majority of those costs are still spent on potentially preventable complications. Although rates of some complications are reducing, prevalence continues to increase and effective approaches to primary and secondary prevention continue to be needed. Improvements in data capture, data quality and reporting, and further research on the human and financial implications of increasing incidence of Type 2 diabetes in younger people are recommended.

Respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), are common in England with the worst respiratory outcomes observed in the most deprived areas. There is limited published research to establish whether the rate of oral corticosteroid (OCS) prescribing for asthma and COPD is linked to levels of deprivation. This study carried out a multivariable regression analysis of publicly available data and found that deprivation is associated with a statistically significant increase in the proportion of patients receiving an OCS prescription for asthma or COPD at a GP practice level (p < 0.001). The model estimated that the proportion of prescriptions is 1.88% (95% CI 1.83% to 1.92%) and 2.84% (95% CI 2.70% to 2.98%) for the least deprived GP practice and the most deprived GP practice, respectively. This study lays the groundwork for future research using individual patient level data to consider the impact of variation in OCS prescribing rates.

Objectives: Increasing uptake and completion of Pulmonary Rehabilitation in people with COPD has the potential to deliver health benefit and reduce health inequalities. We have quantified the cost-effectiveness of enhancing PR access and completion by reviewing the cost-effectiveness literature for PR in COPD. Methods: A literature review identified studies that provided cost-effectiveness evidence for PR compared to no PR. The key metrics of interest were healthcare resource use and cost savings, and quality adjusted life year (QALY) gains. Healthcare resource use data were valued using the UK NHS National Tariff 2022/23. From the literature search we identified the QALY gain resulting from completion of PR. The value of the QALY gain resulting from PR completion was calculated using the standard willingness-to-pay threshold of 20,000 pound considered by the UK National Institute for Health and care Excellence (NICE). Results: We estimated a QALY gain resulting from completion of PR of 0.065 and value of the QALY gain was therefore calculated to be 1300 pound per person completing PR. We estimated the 12 month reduction in hospitalisation following completion of PR to be 8.2% giving a total cost reduction per patient of 245 pound. We therefore calculated that up to 1545 pound could be spent per person with COPD to deliver PR cost-effectively. Conclusion: Our analysis provides commissioners with the information they need to make informed decisions about planning and provision of PR. The data allows estimation of additional resources that could be deployed in addressing inequitable access to PR among disadvantaged and underserved populations whilst retaining cost effectiveness of the intervention.

IntroductionThere is an ever-increasing demand for social care in the UK, with expenditure predicted to double to £56 billion by 2038/39. Many councils are under budget restrictions putting pressure on the number of services provided and their quality. Telecare complements social care and involves the implementation of technology to keep individuals more independent.MethodsThis study utilised a retrospective time-series analysis of data provided by Lancashire County Council between the period January-2013 to March-2018. A generalised linear mixed model (GLMM) was used to control for potential confounders. Two groups were identified: those using telecare (telecare group, n = 699) and those who did not (control group, n = 839).ResultsThe fixed effects data showed that telecare group start £75 per week lower in cost and as time progressed this reduced further by 9p per service user per week. In contrast, control group costs rose 5p per week per user. This effect was independent of age but was affected by measure of dependency. Analysis was then utilised to make predictions based on weighted averages. The scenario showed a total difference of £4,949 per service user over the whole year. A second scenario pro-rata'd costs for the full year showed a difference of £6,214, where telecare would avoid costs of £17 million per year.DiscussionThis analysis demonstrates that there is evident potential for the use of telecare to reduce social care resource use and costs. This study also highlights the use of a GLMM as a novel method of analysing observed data by controlling confounders.

Introduction Opioid prescribing rates are disproportionately high in the North of England. In addition to patients’ complex health needs, clinician prescribing behaviour is also a key driver. Although strategies have been initiated to reduce opioid prescribing nationally, the COVID-19 pandemic has interrupted service provision and created challenges for the system and health professionals to tackle this complex issue. A pilot intervention using smartphone video messaging has been developed to remotely explain the rationale for opioid reduction and facilitate self-initiation of support. The aim of this study is to evaluate the potential benefits, risks and economic consequences of ‘at scale’ implementation. Methods and analysis This will be a mixed-methods study comprising a quasi-experimental non-randomised before-and-after study and qualitative interviews. The intervention arm will comprise 50 General Practitioner (GP) Practices using System 1 (a clinical computer system hosting the intervention) who will deliver the video to their patients via text message. The control arm will comprise 50 practices using EMIS (a different computer system) who will continue usual care. Monthly practice level prescribing and consultation data will be observed for 6 months postintervention. A general linear model will be used to estimate the association between the exposure and the main outcome (opioid prescribing; average daily quantity (ADQ)/1000 specific therapeutic group age-sex related prescribing unit). Semi-structured interviews will be undertaken remotely with purposively selected participants including patients who received the video, and health professionals involved in sending out the videos and providing additional support. Interviews will be audio recorded, transcribed and analysed thematically. Ethics and dissemination Ethics approval has been granted by the NHS Health Research Authority Research Ethics Committee (22/PR/0296). Findings will be disseminated to the participating sites, participants, and commissioners, and in peer-reviewed journals and academic conferences. Trial registration number NCT05276089 .

Monitoring nutritional intake is of clinical value, but few existing tools offer electronic dietary recording, instant nutritional analysis, and a platform connecting healthcare teams with patients that provides timely, personalised support. This feasibility randomised controlled trial tests the usability of ‘myfood24 Healthcare’, a dietary assessment app and healthcare professional website, in two clinical populations. Patients were recruited from a weight management programme (n21) and from a group of gastroenterology surgery outpatients (n = 27). They were randomised into three groups: standard care, myfood24, or myfood24 + diet optimisation (automated suggestions for dietary improvement). The participants were asked to record their diet at least four times over eight weeks. During the study, healthcare professionals viewed recorded dietary information to facilitate discussions about diet and nutritional targets. The participants provided feedback on usability and acceptability. A total of 48 patients were recruited, and 16 were randomised to each of the three groups. Compliance among app users (n = 32) was reasonable, with 25 (78%) using it at least once and 16 (50%) recording intake for four days or more. Among users, the mean (standard deviation) number of days used was 14.0 (17.5), and the median (interquartile range) was six (2.5–17.0) over 2 months. Feedback questionnaires were completed by only 23 of 46 participants (50%). The mean System Usability Score (n = 16) was 59 (95% confidence interval, 48–70). Patient and healthcare professional feedback indicates a need for more user training and the improvement of some key app features such as the food search function. This feasibility study shows that myfood24 Healthcare is acceptable for patients and healthcare professionals. These data will inform app refinements and its application in a larger clinical effectiveness trial.

This pragmatic review provides a summary of the recently published economic cost of four preventable diseases in the UK (type 2 diabetes, obesity, myocardial infarction, and stroke). A MEDLINE (OvidSP) search strategy was designed to identify UK studies reporting economic costs. The search was restricted to UK papers from 2016 onwards. 1,590 records were screened based on title/abstract. 86 were reviewed for eligibility and 20 included. 17 studies were extracted, including retrospective studies preceding 2016 with some overlap between diseases. Comparability was difficult due to the variety of methods and models being used, for example: One diabetes study estimated costs of >£3Bn associated with poor glycaemic control, and another estimated costs of £5.6Bn/year for hospital care. Obesity studies estimated incremental per obese person costs compared with the general population and by magnitude of obesity but did not estimate an overall direct and societal cost. Myocardial infarction studies also estimated incremental per patient costs. One study estimated a potential saving of £68Bn to the health and social care system over 25 years if people at high risk of cardiovascular disease were detected and managed. Atrial fibrillation is estimated to cost the UK health system between £8 and £16Bn. A stroke study estimated the annual UK health and social care cost will be £17Bn in 2025, while a 2017 European study estimated the annual direct and societal cost to the UK at €7.5Bn. These representative preventable diseases impose strong collective pressure on the healthcare system and are costly. These examples also show that delayed action increases the economic burden. Longer-term care represents a significant burden on a constrained health and social care system which the Covid-19 pandemic has further highlighted as fragile. Action should be taken now against preventable disease to help protect the NHS from future shocks.

In many countries, private companies provide primary care services based predominantly on offering video consultations via smartphones. One example is Babylon GP at Hand (BGPaH), which offers video consultations to National Health Service patients, 24 hours a day, and has grown rapidly in London over the last 3 years. The development of this type of service has been controversial, particularly in the United Kingdom, but there has been little formal published evaluation of these services in any country. This paper outlines the main controversies about the use of privately provided video consultation services for primary care and shows how they are informed by the limited evaluations that have been conducted, particularly the evaluation of BGPaH. This paper describes the advantages of these services in terms of convenience, speed of access, the ability to consult without traveling or face-to-face patient-doctor contact, and the possibility of recruiting doctors who cannot work in conventional settings or do not live near the patients. It also highlights the concerns and uncertainties about quality and safety, demand, fragmentation of care, impact on other health services, efficiency, and equity. There are questions about whether private primary care services based on video consultations have a sustainable business model and whether they will undermine other health care providers. During the recent COVID-19 pandemic, the use of video consulting has become more widespread within conventional primary care services, and this is likely to have lasting consequences for the future delivery of primary care. It is important to understand the extent to which lessons from the evaluation of BGPaH and other private services based on a video-first model are relevant to the use of video consulting within conventional general practices, and to consider the advantages and disadvantages of these developments, before video consultation–based services in primary care become more widely established.

Aim To estimate the potential benefits in terms of avoided complications and cost reduction if the Spanish health system would encourage the intensification of treatment for better glycaemic control in adults with Type 2 diabetes from the current HbA1c target used in clinical practice of 68 mmol/mol to a target of 53 mmol/mol. Methods The IQVIA Core Diabetes Model (version 9.0) was used to model the impact of these changes in respect of micro- and macrovascular complications and the associated costs. The modelling was based on data derived from the SIDIAP-Q population database from Catalonia, taking a random cohort of 10,000 people with type 2 diabetes and dividing it into sub-groups based on their basal HbA1c. Results The CDM modelling showed that the average cost reduction per person varies depending on basal HbA1c. The model estimates that after 25 years, people with a basal HbA1c between 48 and 58 mmol/mol and >75 mmol/mol show an average cost reduction of €6,027 and €11,966, respectively. Applying the per-person cost reduction to the cohorts of the prevalent population in Spain (1,910,374) the overall estimated cost reduction was €14.7 billion over 25 years. The improvements in outcomes resulted in an estimated reduction of more than 1.2 million complications cumulatively over 25 years, of which more than 550,000 relate to diabetic foot and more than 170,000 related to renal disease. Conclusion Over a 25 year period, Spain could considerably reduce costs and avoid major complications if, on a population level, more ambitious glycaemic control, according to Spanish or EU guidelines, could be achieved among people with type 2 diabetes by reducing the HbA1c threshold for treatment intensification. Although there is a slower trajectory for benefits in earlier years, there is a much more rapid benefit gain between years 5 and 15.

Aims To revisit the data analysis used to inform National Institute of Health and Care Excellence (NICE) NG17 guidance for initiating basal insulin in adults with type 1 diabetes mellitus (diabetes). Methods We replicated the data, methodology and analysis used by NICE diabetes in the NG17 network meta-analysis (NMA). We expanded this data cohort to a more contemporary data set (extended 2017 NMA) and restricted the studies included to improve the robustness of the data set (restricted 2017 NMA) and in a post hoc analysis, changed the index comparator from neutral protamine Hagedorn (NPH) insulin twice daily to insulin detemir twice daily. Results The absolute changes in HbA(1c) were similar to those reported in the NG17. However, all 95% credible intervals for change in HbA(1c) point estimates crossed the line of null effect, except for detemir twice daily (in the NICE and extended 2017 NMAs) and NPH four times daily. In the detemir twice-daily centred post hoc analysis, the 95% credible intervals for change in HbA(1c) crossed the line of null effect for all basal therapies, except NPH. Conclusions In NG17, comparisons of basal insulins were based solely on efficacy of glycaemic control. Many of the trials used in this analysis were treat-to-target, which minimize differences in HbA(1c). In the NMAs, statistical significance was severely undermined by the wide credible intervals. Despite these limitations, point estimates of HbA(1c) were used to rank the insulins and formed the basis of NG17 guidance. This study queries whether such analyses should be used to make specific clinical recommendations.

Purpose The aim of the NHS England Vanguards of new care models was to improve healthcare provision and integration through the coordination of services, seeking to deliver the Five Year Forward View. The purpose of this paper is to report on an extensive analysis of one of the Vanguard programmes, exploring whether the implemented integrated response service (IRS) based in Harrogate, England, resulted in any meaningful change in secondary healthcare activity. Design/methodology/approach The authors used an interrupted time series framework applied to aggregate secondary care data, specifically emergency attendances for patients 65+, emergency bed days for all adults and non-elective admissions for 65+. Synthetic and geographic comparator data were employed to inform additional scenario analyses. Findings The majority of the analyses conducted found no statistically significant effect of the IRS team in either direction, suggesting that there was no change in the metrics that could be separated from natural variation. The data correlated with the findings of a qualitative analysis and challenges faced in staffing the team towards the end of the analysis period and the eventual disbanding of the IRS. Research limitations/implications The analysis was partially hampered by data access challenges, limited to poorly specified aggregate secondary care data, and a poorly specified intervention. Furthermore, the follow-up period was limited by the disbanding of the service. Originality/value This analysis indicates that the Harrogate-based IRS team is unlikely to have delivered any sustained quantifiable impact on the intended secondary care outcomes. While this does not necessarily demonstrate a failure of the core principle behind the drive for integrated care, it is an important exploration of the challenges of evaluating such a service.