The National Institute for Health and Clinical Excellence (NICE) has issued a costing report and template to accompany its guideline on the management of hypertension.

The costing report looks at the resource impact of implementing the NICE
guideline in England. Because of the breadth and complexity of the guideline, the report focuses on new or changed recommendations that are considered to have the greatest resource impact and therefore require the most additional resources to implement or that can potentially generate savings.

The costing template produced to support this guideline enables organisations in England, Wales and Northern Ireland to estimate the impact locally and replace variables with ones that depict the current local position. A sample calculation using this template showed by the 5th year after implementation a saving of £20,000 could be made for a population of 100,000.

According to the report, implementing the clinical guideline will bring the following benefits (taken directly from source):

• In the first year following implementation it is expected to need additional funding.

• In future years, as more people benefit from more accurate diagnoses using ambulatory blood pressure monitoring (ABPM), a cumulative effect of people not being on antihypertensive drugs starts to be seen. Savings from reduced treatment costs (because of not providing treatment for people who are not truly hypertensive) will start to outweigh the additional costs of diagnoses.

• This saving may increase further from a continuation of this cumulative effect. However, in the longer term savings are difficult to model accurately because future trends and practice are uncertain. People originally diagnosed as not hypertensive (using ABPM) may develop hypertension later and this makes estimating patient numbers and cost impact very complex. It is anticipated that the year 5 level of savings will be the minimum recurrent saving if the recommendation is fully implemented. This calculation does not include potential longer-term savings from a reduction in adverse events, such as strokes and myocardial infarction, as a result of more accurate diagnosis and therefore more appropriate treatment of hypertension. This has not been quantified in the model because of the long-term nature of the savings, and the uncertainty about such costs and savings.

• Estimated savings are based on comparison with current practice and with population and demographic factors unchanged over time. In practice, the incidence of suspected hypertension is increasing, and likely to continue to increase because of the ageing population and lifestyle factors. Therefore, total spending in real terms may not decrease over time as described. However, the use of ABPM will provide savings compared with continued use of clinic blood pressure monitoring to confirm hypertension diagnoses.

Please see links below for detailed analyses.