Diabetes: NDH annual HbA1c or FPG test

Indicators

The percentage of patients with non-diabetic hyperglycaemia who have had an HbA1c test in the preceding 12 months.

Introduction

Early identification of people with non-diabetic hyperglycaemia who have progressed to type 2 diabetes allows treatment to be started promptly and before complications have developed. NICE therefore recommends annual HbA1c testing for people with non-diabetic hyperglycaemia.

This statement covers a new indicator that is part of the NICE menu of indicators for general practice, following the recommendations of the NICE indicator advisory committee in June 2017.

This statement considers the likely resource impact of the proposed indicator in terms of the number of additional blood tests carried out.

Resource impact

There are around 54.8 million people England, of which 44.4 million are aged 16 and over (see Office for National Statistics data 2015). The prevalence of non-diabetic hyperglycaemia in people aged 16 and over is 11.4% (see Public Health England's Analysis of non-diabetic hyperglycaemia prevalence in England), equivalent to around 5.1 million people in England.

Assuming that achieving the indicator will need 5 minutes of practice nurse time to take blood samples for testing (see Unit Costs of Health and Social Care 2016) and a blood test to be carried out (see the Department of Health and Social Care's NHS reference costs 2015 to 2016), the total unit cost per person is £6.

Table 1 shows estimated cost at achievement levels of 40% to 80%, assuming that current practice is around 26.1% (Pilot data, University of Birmingham and York Health Economics Consortium). These estimates assume all people with non-diabetic hyperglycaemia have been identified and may therefore overstate the actual cost of achievement.

Table 1 Estimated annual cost of implementing indicator IND172

	Proportion	Population	Unit cost (£)	Total (£)
England population		54,786,327
Population aged 16 years and over		44,381,213
Prevalence of non-diabetic hyperglycaemia in people aged 16 and over	11%	5,059,659
Current practice (proportion that have had an HbA1c test in preceding 12 months)	26%	1,320,350	6.00	7,922,100
Total cost of current practice				7,922,100
Future practice at 40% (achievement of indicator)	40%	2,023,864	6.00	12,143,200
Total cost of future practice				12,143,200
Resource impact at 40% (cost of future practice less cost of current practice)				4,221,100
Future practice at 80% (achievement of indicator)	80%	4,047,727	6.00	24,286,400
Total cost of future practice				24,286,400
Resource impact at 80% (cost of future practice less cost of current practice)				16,364,300

The annual resource impact of implementing indicator IND172 is estimated to be approximately £4.2 million at 40% achievement and approximately £16.4 million at 80% achievement. This does not include any savings which may be made as a result of earlier identification and management of people who have developed type 2 diabetes.