The economic cost and carbon burden of long acting injections
Maughan, Lillywhite & Cooke
Introduction
Results - local
The NHS in England is estimated to be responsible for the
emission of approximately 21 million tonnes of carbon dioxide
equivalents per annum. In order to meet the targets set by the
2008 Climate Change Act, every sector of the NHS will have to
deliver substantial carbon savings.
Hot-spot analysis reveals that the dominant financial cost and
carbon burden are associated with the appointment; that is
providing, staffing, maintaining and provisioning the infrastructure
in which the LAI is administered. Medication is ranked in second
place but is responsible for only 13/14% of the overall burden while
medical consumables and travel are insignificant costs and burdens.
Guidance states that long lasting injections (LAIs) of antipsychotic
medication should be given at their maximum possible interval to Table 1. Economic and environmental costs of Flupentixol
minimise pain to patient, but current evidence suggests that for Decanoate per month for Oxford Health NHS Foundation Trust
Flupentixol (antipsychotic) this guidance is not followed. It can be
Resource
Financial
Financial cost
Carbon footprint
Carbon cost
given every 5 weeks but the national average is 2 weekly.
cost
(% burden)
(kgCO2e/month)
(% burden)
Evidence also suggests that no clinical improvement is gained
(£/month)
from Flupentixol doses higher than 50mg every 4 weeks.
Medication
323
13
139
14
However, the national average dose is 60mg per week.
Aims
This paper examines the economic and environmental costs
associated with LAIs of Flupentixol Decanoate.
Needle & syringe
13
<1
0.9
<1
Appointment
2,096
82
717 (energy cost)
75
Travel
117
5
103
11
Total
2,549
100
959.9
100
Table 3. Carbon footprint savings that could be achieved by
increasing interval of LAI from 2 weeks to 5 weeks
Resource
Potential carbon footprint
Potential carbon footprint savings for
savings for each patient
England (kgCO2e/year)
(kgCO2e/year)
Medication
12
65,762 (actual cost from national
prescribing costs data)
16,615 (from study data)
Needle and syringe
0.2
137
Appointment (energy
172
109,200
Travel
25
15,708
Total
209.2
190,807
cost)
Table 4. Financial savings that could be achieved by increasing
interval of LAI from 2 weeks to 5 weeks
Resource
Medication
Potential financial savings
Potential financial savings nationally
for each patient (£/year)
(£/year)
28
152,935(actual cost from national
prescribing costs data)
38,640 (from study data)
Methods
Results – national
This retrospective service analysis examines the prescribing
regime for Flupentixol Decanoate at the Oxford Health NHS
Foundation Trust in England and then extrapolates the results to a
national level. It compares the costs of current practice versus
costs if guidance were adhered. This is a component or bottomup analysis based upon the collection of patient-level activity
data. The assumption is that the results from the Oxford Health
NHS Foundation Trust are typical of English prescribing practices.
The national cost for Flupentixol was available and was used
instead of the local figure. The prescription details of 28 patients
receiving Flupentixol were collated from pharmacy records during
December 2013.
Hot-spot analysis reveals that the dominant financial cost and
carbon burden again are associated with the appointment.
Medication is ranked in second place but is responsible for a larger
proportion of the overall burden (26%/29%) while medical
consumables and travel are again insignificant costs and burdens.
At a national level medication contributes a larger proportion as
costs of the medication are more significant
There are substantial
reductions in cost and
environmental impact
that can be made if
best
practice
is
achieved nationally.
Table 2. Economic and environmental costs of Flupentixol Decanoate
per year for England
Resource
Financial cost
Financial cost
Carbon footprint for
Carbon cost
for England
(% burden)
England
(% burden)
(£/year)
(kgCO2e/year)
Medication
210,000
26%
90,300
29%
Needle and syringe
3,624
<1%
244
<1%
Appointment
570,000
70%
195,000
62%
Travel
31,800
4%
28,050
9%
Total
815,424
100%
313,594
100%
Needle and syringe
3
2,029
Appointment
503
319,200
Travel
28
31,800
Total
562
505,964
Conclusions
There are two issues that lead to unnecessary costs. The
prescribing of medication at doses higher than evidence suggests
is beneficial and the administration of the LAI in shorter intervals
than is necessary. These issues lead to unnecessary impacts in
three domains: environmental, economic and social. The
environmental and economic costs have been outlined, but the
social costs are also significant and include time spent by the
patient attending unnecessary appointments and overmedication leading to disabling physical side effects. These three
domains constitute the triple bottom line of sustainability
assessment and define the broader impacts of any intervention in
health care. Here we can see the potential benefits that can be
achieved across these domains if best practice is adopted.