Saving lives and saving money

The National Clinical Director for Cardiovascular Disease Prevention reviews an important new resource that helps local commissioners measure the value of quality improvement in stroke prevention.

Imperial College Health Partners has this week launched a great new free resource for CCGs – to calculate the cost and benefit of improving care for people with atrial fibrillation (AF).

AF is the most common abnormality of heart rhythm and causes about 20% of strokes each year.

If you have AF your chances of having a stroke increase by a factor of five, and an AF stroke is much more likely to kill or cause severe disability. At the same time, treatment with blood thinning anticoagulants is highly effective and reduces the stroke risk by about two thirds.

AF is, of course, a disaster for individuals and their families. It is also very expensive for the NHS, with initial costs being around £12,000, and social care costs over five years approaching £40,000. So, preventive treatment is a high value intervention.

However, despite the effectiveness of anticoagulation, late diagnosis and under treatment is common. About 340,000 people in England have AF but are unaware of it and, of those who are diagnosed and at highest risk, almost one in five are not receiving treatment.

The recently published Size of the Prize reveals just how big the numbers are in every Sustainability and Transformation Partnership (STP) area. Indeed, across England it shows that if every person with high-risk AF was anticoagulated, this would prevent an additional 14,220 strokes over 3 years.

NHS RightCare is now rolling out the CVD Prevention Pathway across the country, supporting CCGs and STPs to improve detection and management of the high-risk conditions for cardiovascular disease (CVD) including AF. The new AF Budget Impact Model from Imperial College Health Partners shows for every CCG the magnitude of current gaps in care, the costs of improving detection and treatment, the number of strokes prevented, the costs of stroke and major bleeds, and the health and social care savings delivered by preventing strokes.

Local economies can put in local data where they have it, for example on costs of interventions, and can tweak assumptions (eg rates of progress) and projections (eg percent use of newer anticoagulants). Costs and savings are then derived for years 1, 2 and 3 for the CCG, and can be calculated net or inclusive of social care costs. The output from the model can then be used to generate a local business case for improvement.

The bottom line is helpful because it confirms that there is early and substantial return on investment in stroke prevention. For England as a whole, if case-finding costs and social care savings are excluded, financial benefit is achieved in year one. If case finding costs are included but social care savings excluded, financial benefit is achieved in year 2. And if both case-finding and social care is included, net financial savings are achieved in year 1.

This real-world modelling shows why CVD prevention was highlighted in the Next Steps on the Five Year Forward View as a ‘funding and sustainability’ priority for CCGs.

Preventing AF strokes at scale saves lives – and saves money in the short term. Can we afford not to do it?

Follow Matt on Twitter: @DrMattKearney

Dr Matt Kearney

Matt Kearney is NHS England’s National Clinical Director for Cardiovascular Disease Prevention and a GP in Shropshire. He has been working for both NHS England and Public Health England since 2013, and has led development of the NHS Long Term Plan CVD Prevention Programme.

In particular, he has focused on driving system change to help the NHS to get serious about prevention of heart attacks, strokes and other vascular conditions – through clinical leadership, better use of data, and new ways of working that support primary care to improve outcomes for patients and communities.

Previously Matt worked as clinical and public health advisor to the Department of Health respiratory programme, and was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013. He has a Master’s Degree in Public Health and is a Fellow of both the Royal College of GPs and the Royal College of Physicians.