Informing Commissioning Decisions

Using B-natriuretic peptide testing to assist in the early, accurate diagnosis of heart failure improves patient outcomes and reduces costs and is part of The National Institute for Health and Clinical Excellence (NICE) guidance.

Scenario Generator was used to help Primary Care Trust to simulate the impact of implementation. By seeing the simulated improvement in patient outcomes and reduction in costs—£13.7m a year nationally – PCTs were able to make the decision to adopt the guidance.

Evidence-based Decision-Making in Heart Failure

Heart failure referrals currently cost the NHS more than £35million per year and NHS Improvement projects have shown that of patients referred for heart failure, up to 70% do not have it and more than 30% have no cardiac cause for their symptoms. B-natriuretic peptide is a simple blood test that can be used to rule out heart failure with 98% accuracy and for those identified, diagnosis and treatment can be accelerated and patient outcomes improved.

A survey of cardiac networks by NHS Improvement in August 2009 showed that only 46% of primary care trusts (PCTs) provided this test in primary care.

Scenario Generator was used as a timely, cost effective method for establishing the effect of introducing the test, its impact on patient outcomes and overall costs savings.

The simulation was originally created by East Riding PCT and NHS Improvement subsequently developed it further for national use to speed up adoption.

Evidence for Change

The current heart failure pathway was created in Scenario Generator (see right) using population and prevalence data, and the pathway costs calculated. The proposed new pathway to include serum NP testing was then mapped and costed as before. A number of best and worst case scenarios were also developed in order to explore all the potential ways the test could be implemented. The resulting cost modelling was then presented to commissioners and clinicians in each PCT and discussed so that they could choose the pathway that best suited their requirements.

Following the implementation of the test, each PCT modelled has been followed up and had the results validated against the predicted savings shown in Scenario Generator,

As a result of the modelling a further 27 PCTs have asked for modelling and this has been completed in 13 giving total predicted savings of £2.67m per year.

For more information on this project:

Download this case study as a PDF

N.I.C.E guidance report on the project

NHS Improvement Case Study PDF

East Riding of Yorkshire Case Study PDF