Resource impact summary report

Resource impact summary report

This report and the accompanying template support both the NICE technology appraisal for tirzepatide and the NICE guideline for overweight and obesity management. The report and accompanying template also replace the existing report and template for NICE technology appraisal for semaglutide (TA875) and for liraglutide (TA664). The template gives an overview of a variety of different interventions for people with overweight and obesity and allows users to build a comprehensive view of resource requirements.

NICE has recommended tirzepatide, semaglutide and liraglutide as options for managing overweight and obesity, full recommendations are available in: 

The NICE guideline on overweight and obesity management (NG246) has made a range of recommendations across the management of overweight and obesity, the resource impact tools are focused on recommended changes to the referral criteria for bariatric surgery and low and very-low calorie diets as new treatment options for overweight and obesity.

The level of activity for bariatric surgery is not expected to change as a result of the guidance but the recommendations give clinicians more flexibility in offering surgery to people who can benefit from bariatric surgery without needing to exhaust every other possible treatment first.

Low and very low-calorie diets are currently offered to people with a diagnosis of type 2 diabetes within the last 6 years under the diabetes path to remission programme. The recommendations in the guidance make this available to more people and users are encouraged to assess locally the likely uptake of these interventions.

Eligible population for GLP-1 receptor agonists

Table 1 shows the number of people who are eligible for GLP-1 receptor agonists (tirzepatide, semaglutide, liraglutide) in each of the next 3 years. These figures include the impact of the predicted population growth but do not include any increase in the prevalence or include any adjustment for people who qualify with a lower BMI as detailed in the guidance recommendations.

Table 1 shows the population expected to be eligible for GLP-1 receptor agonists in England, the NHS England commissioning policy will identify the number of people eligible for funding within the first 3 years of implementation
Eligible population Current practice 2024-25 2025-26 2026-27

People eligible for GLP-1 receptor agonists (million)

3.3

3.4

3.4

3.4

The assumptions used to calculate the eligible population are shown in table 2, below:

Table 2 Assumptions and sources for eligible population
Assumption Source

25.4% of adults have a BMI 30.0 to 39.9 kg/m2

Health Survey England

29.5% of these have a BMI 35.0 to 39.9 kg/m2

EAG analysis

66.1% of these have at least 1 weight related comorbidity

Analysis of GP practice data of people with hypertension, dyslipidaemia, obstructive sleep apnoea, atherosclerotic cardiovascular disease, type 2 diabetes, prediabetes and non-alcoholic fatty liver disease

3.5% of adults have a BMI 40.0+ kg/m2

Health Survey England

66.5% of these have at least 1 weight related comorbidity

Analysis of GP practice data of people with hypertension, dyslipidaemia, obstructive sleep apnoea, atherosclerotic cardiovascular disease, type 2 diabetes, prediabetes and non-alcoholic fatty liver disease

Treatment options for the eligible population

The current treatment options available for the eligible population are liraglutide, semaglutide, diet and exercise, very low-calorie diets (meal replacement) and bariatric surgery.

Tirzepatide is a further treatment option and is the first GLP-1 receptor agonist to be recommended for use as an option for treating obesity outside a specialist weight management setting, it is recommended for use in all settings.

For more information about the treatments, such as dose and average treatment duration, see the resource impact template.

Financial resource impact (cash items)

The key drivers of financial resource impact are:

  • the large eligible population

  • drug costs and the cost of wraparound care.

Users should use the template to assess locally the resource impact of implementing the guideline and the technology appraisal guidance.

For further analysis or to calculate the financial impact of cash items, see the resource impact template.

Capacity impact

For analysis or to calculate the financial capacity impact from a commissioner (national) and provider (local) perspective, see the resource impact template.

Using the template

The resource impact template can be used to estimate the resource impact at a variety of local and national levels based on NICE assumptions or user entered assumptions. Wherever light blue cells are present, users can enter missing information or amend the information already in the template.

Inputs and eligible population

This tab is used to calculate the eligible population and input uptake and the price of the various interventions available to the population. There is a requirement to enter the number of people assessed for medicines in a non-specialist setting, the proportion who will go onto have the medicine and the proportion who will have either face to face or digital support. This is to ensure the capacity impact for the initial assessment is captured for all patients undergoing the assessment.

Resource requirements

This tab is used to input the number and length of various capacity impacting elements of interventions such as GP appointments, nurse appointments, dietician support etc. and the staff band and pay grade of the person delivering the intervention. This is split between specialist and non-specialist settings. Users can input an appointment length and the number of appointments required for a variety of interventions per person per year and this will feed into calculations in the capacity tabs.

Unit costs

This tab is used to calculate the annual cost of various interventions based on information entered into the 'inputs and eligible population' tab and additional information entered directly into the blue cells in this tab. The unit costs calculated in this tab are used in combination with the eligible population and uptake data to assess the annual resource impact in the 'Financial impact (cash)' tab. Weighting for the dose in use are considered for tirzepatide to calculate the average cost for the population having tirzepatide.

Summary

This tab summarises the resource impact in cash and capacity terms using information entered in the first 3 tabs.

Financial impact (cash)

This tab gives a breakdown of the annual cash cost of implementing the guidance based on information entered in the inputs and eligible population and unit costs tabs. Some of the information in this tab is summarised in the summary tab.

Capacity non specialist services and Capacity specialist services

These tabs calculate the capacity impact of implementing the guidance for specialist and non-specialist weight management settings based on information entered in the inputs and eligible population and resource requirement tabs. Some of this information is summarised in the summary tab.

Payscales

This tab lists the different payscales included in the template that can be selected in the resource requirements tab.

Key information

Table 3 Key information

Time from publication to routine commissioning funding

For the funding variation cohort identified: 90 days in specialist weight management settings, 180 days in non-specialist settings

Commissioner(s)

Integrated care boards

Provider(s)

Specialist and non-specialist weight management services

Pathway position

Can be used at any stage of treatment in combination with diet and exercise.