Whilst responding to a question on the diabetes.co.uk forum, I uncovered the JBDS paper on avoidance of admissions for diabetes.
This makes for very interesting reading, not least from a cost perspective. For me, some of the highlights are:
- In the period 2010/2011, the hospitals admissions statistics showed there were 21,116 admissions due to DKA.
- For Hypoglycaemia, the available data suggest between 70,000 – 100,000 emergency call-outs per annum in the UK, at significant cost which equates to about 1% of all call outs. The majority of these are treated at home/on location.
- In 2011- 2012, there were 11,759 admissions due to hypoglycaemia (NHS Information Centre) accounting for 45,502 bed days across all ambulance trusts.
Let’s take the hypo-related statistics on their own, with a couple of costs thrown in…
- The cost of an ambulance call out is roughly £240
- Cost of a bed day (2013/2014 data) is roughly £700
- Cost of an A&E visit (2013/2014 data) is roughly £114
Taking that in context:
- Ambulance call outs as a result of hypos cost £24,000,000 annually
- Bed days as a result of hypos cost £31,851,400 annually
If we could halve both of these numbers then we could save £27,925,700, yes that’s essentially £28 million.
This looks as though a substantial amount of money could be saved per annum on hypo admissions alone. But looking into this, how big a deal is it really?
Amongst other things, the JDBS recommends that Structured Education should be provided for all T1s. You might ask the question, why not recommend the use of CGM and pumps with integrated insulin suspension. Surprisingly, or perhaps not, the figures don’t stack up! Over a four year period, you’d only be able to supply 1,334 pumps with auto-suspend at current private prices (plus all the consumable gear and CGM sensors) if that could be guaranteed to halve the costs. You’d have to pick and choose very carefully how these might be distributed to reduce the admission costs.
Providing every single UK diabetic with an integrated suspend pump costs way more than the cost of the emergency admissions for Hypoglycaemia. £5.5bn more over four years in fact. Structured Education looks, more than ever, like the cost effective way to handle it. To the man in the street, £55 million looks like a lot of money. To the NHS it’s a rounding error.
Even the costs of treating DKA and the admissions associated with it remain a rounding error, and I haven’t broken them out in detail!
In my brief interlude with the costs of various aspects of care in the NHS, I have to admit that I was surprised at how llttle, in real terms, Diabetic Hypoglycaemia really costs the NHS. If you look at the overall costs of Diabetic care (which is estimated at £9.8bn split £1bn to type 1 and the rest to type 2), it is a drop in the ocean. Half of a percent, and it incorporates both Insulin and Sulfonylurea emergency call outs, not just those for whom CGM integrated pumps might stop the issue.
It highlights very effectively why the NHS simply doesn’t hand out CGM integrated pumps willy nilly and pay for the CGM as part of that. Whilst I often rail against the value for money calculations that the NHS uses, even a very basic one in this context seems to make sense and is exceptionally hard to argue with. The quality of life argument might, however, provide a different result.
As Partha Kar said recently at #DPC2015, “If I want to supply one thing, which area of care do I take the money away from to do so?”. A conundrum at the heart of many of the issues the NHS sees.
Leave a Reply