Developing a sustainable health and care
system: the role of NICE
Gemma Partridge
Clinical Fellow, NICE
A sustainable health and care system
Health and care sector carbon
footprint was estimated to be 26.6
million tonnes of carbon dioxide
equivalent (MtCO2e) in 2015
SOCIAL
ECONOMIC
ENVIRONMENTAL
39%
of public sector emissions
2
NICE
Improving health and social care
through evidence-based guidance
3
What does NICE offer?
4
Could NICE do more?
Sir Andrew Dillon CBE
CEO of the National Institute for Health and Care Excellence
5
Quantifying the environmental impact of NICE guidance on a care
pathway
methodology
environmental impact
Aim: To contribute towards the development of
that NICE could
use to quantify the
of its guidance by delivering a
proof-of-concept project outlining the feasibility of applying the pathways guidance
from the Coalition for Sustainable Pharmaceutical and Medical Devices (CSPM) to NICE
processes.
6
Current NICE resource impact assessment
Treatments and
adverse effects
People (per 100,000)
Unit Costs (£)
Cost (£)
Warfarin
549
283
155,000
Aspirin
360
32
12,000
Dabigatran etexilate
76
802
61,000
Rivaroxaban
76
767
58,000
Apixaban
76
802
61,000
No treatment
464
0
0
Strokes
59
12,228
719,000
Major bleeds
12
1,173
Current treatments
£
TOTAL COST
14,000
1,080,000
Future treatments
Warfarin
748
283
212,000
Aspirin
40
32
1,000
Dabigatran etexilate
186
802
150,000
Rivaroxaban
186
767
143,000
Apixaban
186
802
150,000
No treatment
253
0
0
Strokes
41
12,228
495,000
Major bleeds
15
1,173
18,000
TOTAL COST
NET COST/SAVING
1,168,000
88,000
7
Future NICE resource impact assessment?
£
+
+
+
8
Coalition for Sustainable Pharmaceuticals and Medical Devices
Guidance
GP
CONSULTATION
PATIENT
TRAVEL
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL
PROCEDURE
CONDITION
SELFMANAGEMENT
= 1.14 kg CO2e
= 7.9 kg CO2e
= 13.8 kg CO2e
= 89.5 kg CO2e
= 35.1 kg CO2e
= 1.6 kg CO2e
= 2.28 m3
= 25.8 m3
= 20.9 m3
= 137.5 m3
= 61.8 m3
= 0 m3
= 1.14 kg
= 0.13 kg
= 0.29 kg
= 0.41 kg
= 0.41 kg
= 0.016 kg
9
Care Pathway: CG180 Atrial Fibrillation
GP
CONSULTATION
x1
+
PATIENT
TRAVEL
x2
+
EMERGENCY
DEPARTMENT
VISIT
x1
+
INPATIENT
BED-DAY
+
x3
SURGICAL
PROCEDURE
x1
+
CONDITION
SELFMANAGEMENT
x1
= Care Pathway
10
Current Treatment
GP
CONSULTATION
+
PATIENT
TRAVEL
+
x2
x1
EMERGENCY
DEPARTMENT
VISIT
+
INPATIENT
BED-DAY
+
SURGICAL
PROCEDURE
+
CONDITION
SELFMANAGEMENT
x1
x3
x1
x1
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL
PROCEDURE
CONDITION
SELFMANAGEMENT
Recommended Treatment
GP
CONSULTATION
x1
+
PATIENT
TRAVEL
x1
+
x0
+
x0
+
x0
+
x3
11
A potential final product
Resource Impact Analysis CG 180
£
+ 88,000
- 102 kg CO2e
+ 23 m3
- 50 kg
12
Reflections
• Is it feasible?
• What are the limitations?
• Is it useful?
13
Plans
• Further proof of concept study to apply environmental impact assessment to other
types of NICE guidance
• Assessing the significance and value of environmental impact assessment to the
system
• Consideration of sensitising NICE’s appraisal process to environmental impact and the
implications this may have in terms of NICE recommendations
14
Acknowledgements
15