Indicator

The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses aged 25 to 84 (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) who have had a CVD risk assessment performed in the preceding 12 months (using an assessment tool agreed with NHS England).

Introduction

This report covers a new indicator that is part of the NICE menu of potential Quality and Outcomes Framework (QOF) indicators for 2016/17, following the recommendations of the NICE indicators advisory committee in June 2015. The indicator has been piloted as part of the NICE QOF indicator development process.

This report considers the likely resource impact of incentivising the interventions associated with the proposed indicators in terms of the number of additional interventions provided and the cost of each intervention. Costs to NHS commissioners are outlined where relevant.

People with schizophrenia, bipolar disorder and other psychoses are reported to be at higher risk of developing CVD. NICE has recommended in its guidelines on psychosis and schizophrenia in adults and bipolar disorder, that people with a high risk of CVD are identified and provided with treatment to reduce that risk. Because of the likely need for more GP input into the process, CVD risk assessment for people with serious mental illness is likely to cost more than for the general population.

Number of people affected

Based on pilot data (University of Birmingham and York Health Economics Consortium) the number of people with schizophrenia, bipolar affective disorder and other psychoses aged 25 to 84 (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) who will require a CVD risk assessment is estimated at around 286,800.

Current care

Pilot data showed the indicator was achieved on average for 12.4% of eligible patients at the beginning of the pilot, equivalent to around 35,600 people.

Proposed care

This indicator incentivises CVD risk assessment for people aged 25 to 84 who have schizophrenia, bipolar affective disorder and other psychoses. In line with NICE guidance, it is assumed that a risk assessment is done using QRISK2 and that treatment with atorvastatin 20 mg is prescribed if the 10-year risk is more than 10%. In line with the pilot data, the above model assumes a GP consultation of 17 minutes is required to discuss the importance of risk assessment and of potential treatment strategies with each patient (see Unit Costs of Health and Social Care).

The population has been split between men and women due to the CVD risk being higher in men. This is taken from NICE's guideline on lipid modification.

Resource impact

Table 1 shows estimated cost at achievement levels of 45% to 80%. 

Table 1 Estimated Annual cost of implementing indicator IND150

	Proportions	Populations	Unit cost (£)	Totals (£)
England population		53,107,169
Eligible population 0.54% of the total population	0.54%	286,779
Achievement of assessment (current practice)	12.4%	35,561	£50	1,778,028
Men aged 25 to 84 years (current practice)	49%	17,399
Women aged 25 to 84 years (current practice)	51%	18,161
Men aged 25 to 84 years CVD risk (current practice)	28.4%	4,941	£18.48	91,318
Women aged 25 to 84 years CVD risk (current practice)	22.2%	4,032	£18.48	74,507
Combined		8,973
Reduction in adverse events (current practice)	0.65%	58	£1,391	80,531
Total cost of current practice				1,863,322
Achievement of assessment at 45% (future practice)	45%	129,050	£50	6,452,521
Men aged 25 to 84 years (future practice)	49%	63,143
Women aged 25 to 84 years (future practice)	51%	65,907
Men aged 25 to 84 years CVD risk (future practice)	28.4%	17,933	£18.48	331,395
Women aged 25 to 84 years CVD risk (future practice)	22.2%	14,631	£18.48	270,389
Combined		32,564
Reduction in adverse events	0.65%	210	£1,391	292,251
Total cost of achievement at 45%				6,762,054
Cost impact of achievement at 45%				4,898,732
Achievement of assessment at 80%	80%	229,423	£50	11,471,149
Men aged 25 to 84 years	49%	112,254
Women aged 25 to 84 years	51%	117,169
Men aged 25 to 84 years CVD risk	28.4%	31,880	£18.48	589,147
Women aged 25 to 84 years CVD risk	22.2%	26,011	£18.48	480,691
Combined		57,892
Reduction in adverse events	0.65%	374	1,391	519,557
Total cost of achievement at 80%				12,021,429
Cost impact of achievement at 80%				10,158,108

The annual resource impact of the implementation of QOF indicator IND150 is estimated to be £4.9 million at 45% achievement and £10.2 million at 80% achievement.

This may be an over estimate of cost and time as the economic model for NICE's guideline on lipid modification assumed that a nurse undertook the risk assessment. Unit costs for CVD treatment and savings from a reduction in adverse events are taken from the costing template for NICE's guideline on lipid modification.

It could also be argued that this is an over estimate of the true cost as the patients the QOF indicator is targeting are at higher risk of CVD events and so are more likely to benefit from assessment and treatment, thus averting costly cardiovascular events in the future. The savings due to a reduction in adverse events in the model above may therefore be understated.

References

University of Birmingham and York Health Economics Consortium (NICE External Contractor), Development feedback report on piloted indicators, 2015.