Financial Implication Report for Ultrasound and Pulsed Electromagnetic Systems (PES) for Bone Healing

Transcription

1 Greater Manchester Clinical Commissioning Groups Financial Implication Report for Ultrasound and Pulsed Electromagnetic Systems () for Bone Healing

2 Introduction Clinical Commissioning Groups (CCGs) across Greater Manchester have inherited Effective Use of Resources (EUR) policies from their predecessor Primary Care Trusts (PCTs). Consequently, there are varying positions regarding the commissioning of certain procedures/treatments across Greater Manchester. Work is now being undertaken by the Greater Manchester Shared Services (GMSS) Policy Team, led by the Greater Manchester EUR Steering Group to align EUR policies across Greater Manchester. Purpose of the Report This report aims to inform the Greater Manchester Chief Finance Officers and Heads of Commissioning of the activity and spend on the use of ultrasound and pulsed electromagnetic systems () for bone healing during financial years 2014/15 and 2015/16 (April to December) for each CCG. The information contained in Appendix 1 has been produced in order to support the decision making process across Greater Manchester. The Greater Manchester Chief Finance Officers and Greater Manchester Heads of Commissioning are asked to review this report to assist in the consideration of the Greater Manchester EUR Policy for the use of ultrasound and in bone healing. Body of the Report The tables attached at Appendix 1 provide details of each CCG s activity and costs on ultrasound and for bone healing based on population data and NICE epidemiology. It also provides an indication of the financial implication of adopting the for each Greater Manchester CCG. We have been advised by our independent Public Health Consultant that initial savings would land in the Providers through reduction in operating theatre time, bed days, number of complications and number of procedures. Commissioners may wish to consider the option of asking Providers to fund EXOGEN machines and related consumables out of these savings. Conclusion Based on this epidemiology, the adoption of this will have an adverse financial impact on all twelve of the CCGs in Greater Manchester, however this is more than offset by the impact on the overall health economy. The activity and costs provided in Appendix 1 may be used as a baseline to measure the impact of the Greater Manchester EUR.

3 Appendix 1 CURRENT SPEND ON ULTRASOUND AND PER CCG: Cost per case Cost per case Cost per case 1/4/15 - FY 1516 CCG 1/4/14-31/3/15 21/12/15 Forecast Bolton 0 2 5, ,688 Bury 0 1 2, ,125 HMR , ,938 Manchester Central 0 2 5, ,688 Manchester North 0 3 7, ,250 Manchester South 2 5, , ,125 Oldham 2 5, , ,250 Salford Stockport 1 2, T&G 2 5, , ,875 Trafford CCG 1 2, , ,250 Wigan CCG 5 12, , ,438 Totals 13 33, , ,625 MODELLING FOR NEW POLICY: (1) Population (2) (3) that do not heal (4) requiring (5) Potential number (6) Cost of EXOGEN unit (excluding outpatient costs) per unit is 2, CCG Bolton 276,800 3, ,313 Bury 185,100 2, ,250 HMR 211,700 2, ,938 Manchester 503,100 6, ,813 Oldham 224,900 2, ,500 Salford 233,900 3, ,063 Stockport 283,300 3, ,875 T&G 219,300 2, ,938 Trafford 226,600 2, ,500 Wigan 317,800 4, ,125 Total 2,682,500 34,877 2, ,313 Notes: 1) Population is taken from 2011 census 2) assumes NICE estimate of 1.3% of population per year for UK 3) NICE estimate 7.5% of fractures do not heal 4) NICE estimate 21.4% of fractures that do not heal show non-union after 9 months 5) NICE estimate around 50% of showing non-union after 9 months are suitable for exogen therapy 6) Cost of EXOGEN unit 2, (excluding outpatient costs) per unit i.e. Bolton (cost of EXOGEN unit) 2, x (potential number ) 29 = 74,313

4 Cost implicatons of new per CCG FY1516 Forecast Bolton CCG 7,688 74,313 (66,625) Bury CCG 5,125 51,250 (46,125) HMR CCG 17,938 58,938 (41,000) Manchester Central CCG 7,688 45,271 (37,583) Manchester North CCG 10,250 60,361 (50,111) Manchester South CCG 5,125 30,181 (25,056) Oldham CCG 10,250 61,500 (51,250) Salford CCG 0 64,063 (64,063) Stockport CCG 0 76,875 (76,875) T&G CCG 35,875 58,938 (23,063) Trafford CCG 10,250 61,500 (51,250) Wigan CCG 38,438 87,125 (48,688) Totals 148, ,313 (581,688)

5 Potential Benefit to Health Economy A Scottish study published in the BMJ cited the cost of non-union (in 2013) to the NHS is between 7,000 and 79,000 per case Mills LA, Simpson AHRW. The relative incidence of fracture non-union in the Scottish population (5.17 million): a 5-year epidemiological study. BMJ Open 2013;3:e doi: /bmjopen Scenario 1: Assuming 7,000 per case not treated with Estimated cost if is not used on cases Bolton CCG 203,000 74, ,688 Bury CCG 140,000 51,250 88,750 HMR CCG 161,000 58, ,063 Manchester Central CCG 123,667 45,271 78,396 Manchester North CCG 164,889 60, ,528 Manchester South CCG 82,444 30,181 52,264 Oldham CCG 168,000 61, ,500 Salford CCG 175,000 64, ,938 Stockport CCG 210,000 76, ,125 T&G CCG 161,000 58, ,063 Trafford CCG 168,000 61, ,500 Wigan CCG 238,000 87, ,875 Totals 1,995, ,313 1,264,688 Scenario 2: Assuming 79,000 per case not treated with Estimated cost if is not used on cases Bolton CCG 2,291,000 74,313 2,216,688 Bury CCG 1,580,000 51,250 1,528,750 HMR CCG 1,817,000 58,938 1,758,063 Manchester Central CCG 1,395,667 45,271 1,350,396 Manchester North CCG 1,860,889 60,361 1,800,528 Manchester South CCG 930,444 30, ,264 Oldham CCG 1,896,000 61,500 1,834,500 Salford CCG 1,975,000 64,063 1,910,938 Stockport CCG 2,370,000 76,875 2,293,125 T&G CCG 1,817,000 58,938 1,758,063 Trafford CCG 1,896,000 61,500 1,834,500 Wigan CCG 2,686,000 87,125 2,598,875 Totals 22,515, ,313 21,784,688 There are also potential saving in the areas of failed joint fusion and failed fusion after surgery but estimates for these at a population level are not currently available.