When the NHS (or more specifically NICE) is deciding whether to fund a new treatment, it uses a calculation to determine the value for money of the treatment. It’s a controversial concept, as of course we don’t like the idea of human life having a price tag, but the NHS has a finite budget and that’s how it’s done. There is a guideline that a treatment should cost no more than £20-30 000 per ‘quality adjusted life year (QALY)‘ except in exceptional circumstances.
QALY is a calculation that takes the length and quality of life that a treatment gives into account. By comparing the QALYs and costs of two treatments, you can see which gives better value for money. In light of NHS cuts, I thought it would be interesting to see how gluten free prescriptions shape up if you put them through the calculation using my own experience as a mini case study. Of course you should do this with lots of clinical evidence, so apologies if I’m not using this it was intended, I am not a health economist.
Cost of current treatment
I don’t currently receive gluten free food on prescription, so the cost of my current treatment is zero (if you just consider the prescriptions – more on that later.)
Current quality of life
Currently, despite my best efforts and being fairly knowledgeable I have a lot of accidents and symptoms, so I would rate my quality of life to be about 90%.
Cost of prescription treatment
I estimate that prescribing me gluten free foods would cost the NHS £211* per year.
Quality of life with the prescription
Of course, prescriptions of food don’t cure glutening altogether, but a good stock of GF foods at home could reduce my eating out and accidents by about 1/3. This would give me a 93.3% quality of life.
Cost per QALY
If we assume the gluten free food is a new pill for coeliac disease that delivers the same improvement in symptoms, following the QALY calculation through* for the example (divide the extra cost of treatment by the extra quality of life per year) gives an incremental cost per QALY of £6342 on the current treatment. It’s well within the NICE guidelines for a treatment to be approved, but we are still seeing cutbacks at the GP level. It’s an easy area to cut, particularly when there is limited clinical evidence of the benefits of prescription treatment versus self-management .
Prescription costs don’t tell the whole story
I can tell you my personal experience of self-management of coeliac disease. Prescriptions aren’t the only cost of coeliac disease to the NHS. If you consider my GP appointments, tests, prescriptions and specialist follow-ups that are needed to deal with the symptoms I get from accidental glutenings and mistakes that arise from frequent eating out and travel. I estimate this cost to be about £895 per year.*
Using my example, prescriptions would mean the NHS would spend 1/3 less on my other trips to the doctors. That added to the prescription costs means the NHS would pay a total of £808 a year to manage my coeliac disease – an £87 saving overall as well as making a small but significant improvement to my quality of life.
So not funding prescriptions is pushing costs from one area of the NHS (drug budget) to another (GP & hospital appointments) – the saving from the prescription budget is hiding the extra costs elsewhere. Presumably the latter are harder to track. (I certainly don’t tell my doctor I have a 3% reduction in quality of life- I tell him I have a headache.)
£87 isn’t a earth-shattering amount. It shows why the NHS must be careful about managing which GF products it prescribes as that saving could quickly be eroded (my example used some of the cheaper prescription items), but an £87 saving for 125, 000 diagnosed coeliacs soon adds up, especially if you consider that many people might receive a greater improvement in quality of life than I would due to prescription. If I was an NHS manager, I would definitely chose the prescriptions. More money to spend and happy coeliactivists? Double win!
So when faced with the need to ‘cut’ gluten free prescriptions, you now have the health economics argument – that GF prescriptions are a cut- they save the NHS money overall.
*if you would like to see my calculations & assumptions, I have uploaded them here.