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					                                    EXECUTIVE SUMMARY




The objective of this clinical and resource impact costing template is to provide each NHS board
with resource and cost information for implementation of those recommendations in SIGN
Guideline 111 Management of hip fracture in older people judged to have a material impact on
resources.

The methodology adopts proven processes and principles. Members of the guideline
development group and other experts have provided advice and participated in peer review.

Clinical and resource impact of recommendations

Hip fracture is a common serious injury that occurs mainly in older people. For many previously fit
patients it means loss of prior full mobility; for some frailer patients the permanent loss of the
ability to live at home. And for the frailest of all it may bring pain, confusion and disruption to
complicate an already distressing illness. Mortality after hip fracture is high: around 30% at one
year. Despite significant improvements in both surgery and rehabilitation in recent decades, hip
fracture remains, for patients and their carers, a much-feared injury.

This clinical and resource impact spreadsheet has been developed to provide each NHS board
with resource and cost information to support the implementation of the recommendations
judged to have a material impact on resources (see below). This document is available from the
NHS QIS website: www.nhshealthquality.org.

The total costs of implementing these recommendations across NHSScotland are estimated to
be £1,728,000 per year. This includes the additional cost of fondaparinux of £1,159,000 less
savings on heparin and aspirin of £111,000; plus £680,000 for 28,000 extra home visits by a
nurse for patients needing injections after discharge.

£173,000 in hospital costs would be saved by the risk reduction in the incidence of symptomatic
DVT from 2.7% to 0.3%, benefiting 149 patients. There would be further savings post-discharge
but these have not been quantified or costed.

Implementation of other recommendations, in particular those relating to multidisciplinary team
working and supported discharge schemes, should reduce acute hospital stay as well as leading
to other patient and clinical benefits. These benefits have not been quantified or costed.
Recommendations costed in the clinical and resource impact template:

- Heparin (UFH or LMWH) or fondaparinux may be used for pharmacological thromboprophylaxis
in hip fracture surgery. (Section 5.5.3)
- Patients without a contraindication should receive thromboprophylaxis using fondaparinux for
28 days starting six hours after surgery (5.5.3)
                         INTRODUCTION and METHODOLOGY
1 Objective

The purpose of NHS Quality Improvement Scotland (NHS QIS) is to drive improvement in
the quality and safety of healthcare for the people of Scotland through the provision and
use of knowledge. NHS QIS is committed to increasing the implementation support it
provides to NHSScotland and provides a range of tools to achieve this.

The objective of this clinical and resource impact costing template is to provide each NHS
board with resource and cost information to assist in implementing those
recommendations in SIGN Guideline 111 Management of hip fracture in older people 1
judged to have a material impact on resources. This template does not reproduce the
SIGN guideline and should be read in conjunction with it. N.b. normally, a clinical and
resource impact report would also be published but this has not been done due to the
limited number of material recommendations.


A recent Audit Commission report2 concluded that the lack of robust information on the
resources required and associated costs is one of the biggest difficulties in developing
plans to implement clinical guidelines. NHS QIS has worked alongside the SIGN guideline
development group to quantify the resources and related costs required to implement the
key guideline recommendations in NHSScotland and the NHS boards. This clinical and
resource impact template aims to provide such information to support implementation of
the material recommendations in NHS boards. It does not attempt to cost all aspects of
the current management of hip fracture.

2 Target Users

This template will be of interest to health professionals involved in budgeting, finance and
implementation in primary care, hospitals, community health services and voluntary and
community organisations.
3 Document overview

This Section describes the methodology adopted. ‘How to use this document’ contains
details of how to use the look up tables and Steps 1, 2 and 3 for the clinical and resource
impact for each NHS board. The Appendices acknowledge those who have contributed to
the development of this template, include more detailed information on the clinical and
resource impact assessment process and list references.
4 Principles, process and participants

The methodology adopted the:

• Process set out in NICE developing costing tools methods guide3.
• Principles in two recent reports on budget impact analysis4,5.
• Findings and recommendations in the Audit Commission report on Managing the
financial implications of NICE guidance2.
• Evaluation of the Resource Impact tools developed alongside the SIGN coronary heart
disease (CHD) guidelines6.

Members of the guideline development group and other experts provided advice and also
participated in peer review.

The recommendations in the SIGN Guideline 1111 were assessed as to the likelihood of
them having a material impact on the resources of NHSScotland. Those selected were
then costed.




5 Stages of the costing process

Discussions with the SIGN guideline development group chair and selected group
members identified:

• Which recommendations were likely to require significant resources to implement.
• If any recommendations were likely to result in significant savings through ending
ineffective practice or improving current ways of working.
• Which recommendations might cause a material change to the numbers of patients
being managed.

Only those recommendations judged to have a potentially material cost impact were
costed. The key cost drivers for each recommendation were identified by:

• Using demographic/epidemiological data published by the Information Services Division
(ISD) and the Scottish Hip Fracture Audit7 (SHFA) on the number of people affected.
• A literature search to identify studies assessing or evaluating the costs and economic
aspects of hip fracture. This included relevant studies identified in the systematic review of
the literature carried out as part of the development of the SIGN guideline.
• Using expert opinion and published information, mainly from relevant websites.
• Assessing the resources involved in current and recommended practices.
• Applying unit cost information obtained in the main from published sources.
A spreadsheet model was used to calculate the national and NHS board cost impact for
each recommendation.

Thanks to the individuals listed in Appendix 1 who provided peer review comments and
the estimates and template were revised in light of comments received.

N.b. the island NHS boards have been excluded from the assessments as all hip fracture
operations are performed on the mainland.

Costs were developed using a ‘bottom-up’ approach. However, for certain procedures, eg
deep vein thrombosis (DVT), the Scottish tariff costs published by ISD have been
adopted’. In such instances relevant staff at ISD were contacted in an effort to ensure the
components of the published cost were fully understood. Costs include VAT, as VAT
payable on drugs and other goods purchased by NHSScotland boards is irrecoverable.

The analyses assume existing staff are fully utilised and re-prioritisation of existing
workload does not take place. In reality re-prioritisation will take place, particularly in
general practice. The estimated staff requirements therefore overstate the future need.


6 Exclusions and limitations

The template is subject to several limitations. These include:

• Uncertainty as to what comprises current clinical practice. Various methods were used to
minimise this, for example discussion with group members and other experts and using
published peer reviewed sources of data.
• Not costing many of the recommendations as they were not judged individually to require
a material change in resource use. However, a number of small changes may aggregate
up to represent a material step change in resource allocation.
• The costs do not capture the downstream resource and consequences of the
recommendations and are therefore likely to understate the implications for NHS boards.
Further information

For further information on this template, or to obtain a copy, contact:

George English
Senior Project Cost Accountant
NHS Quality Improvement Scotland
Delta House
50 West Nile Street
GLASGOW
G1 2NP

0141 227 3278
george.english@nhs.net
Management of hip fracture in older people
HOW TO USE THIS COSTING TEMPLATE



Hip fracture is a common serious injury that occurs mainly in older people. For many
previously fit patients it means loss of prior full mobility; for some frailer patients the
permanent loss of the ability to live at home. And for the frailest of all it may bring pain,
confusion and disruption to complicate an already distressing illness. Mortality after hip
fracture is high: around 30% at one year. Despite significant improvements in both
surgery and rehabilitation in recent decades, hip fracture remains, for patients and their
carers, a much-feared injury.

Average Cost per patient
A study of the hospital costs of treating hip fractures8 estimated that the mean cost per
                                                                           9
patient was £14,220, at 2008 prices. A similar for the Glasgow hospitals showed costs
for Length of Stay of £13,455 plus Theatre £521 = £13,976.

This template provides an estimate of the costs and resources required to implement the
recommendations below by populating the Costing template (STEP 2. Costing template)
with the number of Hip Fractures in each of the hospitals that carry out these procedures.


The Guideline states “Hip fracture surgery carries a high risk of venous thromboembolism
(VTE) including asymptomatic deep vein thrombosis (DVT), symptomatic DVT and
symptomatic pulmonary embolism (PE)… In a large randomised controlled study,
fondaparinux administered either 12 hours before delayed hip surgery (24-48 hours post
admission) or six hours after prompt surgery (within 24 hours of admission) reduced the
risk of thromboembolism compared to the LMWH, enoxaparin during the period of
thromboprophylaxis. Fondaparinux reduced the risk of VTE by 56%, for any DVT by 58%,
for any proximal DVT by 79% and for distal DVT by 55% compared to enoxaparin. Further
data indicate that prolongation of thromboprophylaxis with fondaparinux for a further 19-
23 days reduces the risk of thrombosis from 35% to 1.4% compared with placebo… In
patients with osteoporotic hip fractures, fondaparinux as pharmacological prophylaxis in
reducing the risk of postoperative thromboembolism is cost effective when compared with
enoxaparin. Prophylaxis with fondaparinux is superior in preventing VTE.

• Heparin (UFH or LMWH) or fondaparinux may be used for pharmacological
thromboprophylaxis in hip fracture surgery
• Patients without a contraindication should receive thromboprophylaxis using
fondaparinux for 28 days starting six hours after surgery (section 5.5.3 in SIGN
Guideline 111).
It is possible to change the values assumed in order to tailor the hospital and NHS board
impact to your local circumstances. This is indicated throughout the costing template by
the use of shaded cells (this colour).



This costing template is made up of the following worksheets:

Title page
Can be printed as a cover for reports produced.

How to use this document (this worksheet)
Includes the introduction above and instructions on how to use this costing template.

Look up tables
The Look up tables worksheet outlines all of the assumptions used to develop the model.
The units and costs assumed and the associated costs are provided.
Shaded cells within the table can be changed to more accurately reflect local
circumstances and will update all the costs accordingly.
Note that you can change the value of a parameter either in these look up tables or in the
actual costing template in STEP 2.


It is important to read these instructions before proceeding on to STEP 1. Select Hospital

STEP 1. Select Hospital
Used to populate STEP 2. Costing template and to alter numbers diagnosed if required as
detailed in the instructions below.
Numbers and costs are provided at hospital level, since that is how they are presented in
the Scottish Hip Fracture Audit. Totals for the Health Board are shown by selecting the
Health Board in STEP 1. Select Hospital.

If you want to change the numbers diagnosed, or if you have more recent figures
Different numbers of diagnoses can be entered into shaded columns by clicking on the
cell and entering the new value. To ensure the value is entered into the correct cell for
your hospital, the drop-down menu provided under the 'Hospital' heading can be used to
select your hospital or Health Board.


STEP 2. Costing Template
Provides assumptions and estimates made and can be altered to reflect hospital
circumstances. Notes relating to the assumptions and estimates are also provided here.
Clicking on the numbered hyperlink in the notes column will take you to the corresponding
note.

Adapting costing template to reflect hospital circumstances

To adapt the costing template click on the tab at the bottom of the screen that says 'STEP
2. Costing template'. The worksheet is divided into two sections:
The left section (labelled on template)

The left section describes the model developed. For more information on the
assumptions made and sources, refer to the look up tables and STEP 1. Select Hospital.

The right section (labelled on template)
The hospital or Health Board selected in STEP 1. Select Hospital will be used for the
calculations in this section. The worksheet is protected to prevent formulae being
inadvertently changed, but any shaded cell can be changed to reflect local circumstances.
For example:

Unit costs
The look up tables detail what the costs for activities have been based on. Hospitals will
dictate what their care pathway is, and where services are delivered and therefore costs
may differ.

It is important to note that changing a proportion in one of the shaded cells does not
automatically result in recalculation of the paired proportion. This is to allow for either
proportion to be changed independently.

STEP 3. Costing Report
Summarises the results. If you do not want to amend the estimates then
click here to go direct to this summary
after the desired hospital or Health Board has been selected.

Reviewing the costing report


To view the calculated costs for your hospital click on the tab at the bottom of the screen
that says 'STEP 3. Costing Report', ensuring that your desired hospital has been selected
in STEP 1. Select Hospital. This worksheet summarises the hospital costing template
and provides an estimate of the national cost of the recommendations.

The hospital entered in STEP 1. Select Hospital appears in the title for the costing report.
You may wish to print this sheet and use it as a briefing report to discuss the costing
exercise, or as part of a business case for funds for implementation.



Where to find the Guideline
Contains links to SIGN 111 'Management of hip fracture in older people' A national clinical
guideline.

Comments
Contains a link to provide comments on the usefulness of this template. Your feedback
will help to improve these tools for future use.


George English
Senior Project Cost Accountant
NHS Quality Improvement Scotland
Delta House
7th Floor Delta House
50 West Nile Street
Glasgow
G1 2NP
0141 227 3278
www.nhshealthquality.org/nhsqis
                                                                 LOOK UP TABLES

                                                                      Cost £ 2009
Parameters                                                Units         prices                                   Source


Fondaparinux
% patients without fondaparinux                            95%
contraindication
Arixtra, 0.5-mL (2.5-mg) prefilled syringe                               £6.66      BNF 2008:56

Number of days                                              28                      SIGN Guideline 111

Cost of fondaparinux per patient                                        £186.48

Reduction in use of low molecular
weight heparin and aspirin
Enoxaparin, 40-mg (0.4-mL, 4000-units) syringe                           £4.20      BNF 2008:56

Number of days (average of 7-10 days)                      8.5           £35.70

Aspirin, 75 mg 28-tab pack prefilled syringe                28           £0.51      BNF 2008:56

Number of days (average of 7-10 days)                      8.5           £0.15

% patients prescribed Enoxaprin                            50%

% patients prescribed aspirin                              50%

Average cost of enoxaparin/aspirin per patient                           £17.93

Patients going home direct or via
Rehab
% patients needing a nurse for injection                   90%

Cost for each visit by Community nurse                                   £24.00     PSSRU (2007) Unit costs of health and social care

Risk reduction in incidence of
symptomatic DVT
% risk reduction (from 2.7% to 0.3%)                      2.4%                      Eriksson1
E21 Deep Vein Thrombosis under 70 years old                               £576      07/08 Tariff costs2
without complications
E20 Deep Vein Thrombosis over 69 years old or                            £1,260     07/08 Tariff costs2
with complications
% patients under 70 years old                             14.4%                     Scottish Hip Fracture Audit 20083

% patients over 69 years old                              85.6%                     Scottish Hip Fracture Audit 20083

Average cost reduction per patient                                       £1,162




1
 Eriksson BI, Lassen MR, Pentasaccharide iH-FSPI. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery:
a multicenter, randomized, placebo-controlled, double-blind study. Archives of internal medicine 2003;163:1337-42.
2
 Tariff costs - ISD (www.isdscotland.org/isd/files/0708ScotTariffs.xls)
3
 www.shfa.scot.nhs.uk. Nb patients under 50 are not included
  Management of hip fracture in older people
  Recommendations in sections 5.5.3 of SIGN Guideline 111
  STEP 1. Select Hospital or NHS Board by using the drop down menu in cell               Select Hospital or NHS Board
  Change the number of hip fractures of home days in the coloured cells if required




  Hospital or NHS Board      Select Hospital or NHS Board
                                                                                                                        B                             B
                                                                                            Discharged Straight Home         Discharged Home via Rehab
                                                                       Total number of
         NHS Board                           Hospital
                                                                        hip fracturesA    Total number       Home days      Total number    Home days
Select Hospital or NHS Board Select Hospital or NHS Board
  Ayrshire & Arran         Ayr Hospital                                       210              60               13.9            81              0.8
  Ayrshire & Arran         Crosshouse Hospital                                247              64               14.9            85              1.0
  Ayrshire & Arran         NHS Ayrshire & Arran                               457              124              14.4            166             0.9
  Borders                  Borders General Hospital                           165              31               16.7            98              1.2
  Borders                  NHS Borders                                        165              31               16.7            98              1.2
  Dumfries & Galloway      Dumfries and Galloway Ryl Infirmary                166              26               18.5            107             2.6
  Dumfries & Galloway      NHS Dumfries & Galloway                            166              26               18.5            107             2.6
  Fife                     Queen Margaret Hosp, Dunfermline                   375              144              13.8            89              1.7
  Fife                     NHS Fife                                           375              144              13.8            89              1.7
  Forth Valley             Forth Valley (Stirling RI)                         354              62               19.3            207             3.7
  Forth Valley             NHS Forth Valley                                   354              62               19.3            207             3.7
  Grampian                 Aberdeen Royal Infirmary                           491              46               15.1            261             1.2
  Grampian                 Dr Gray’s Hospital, Elgin                          140              50               19.7            52              1.4
  Grampian                 NHS Grampian                                       631              96               17.5            313             1.2
  Greater Glasgow & Clyde Glasgow Royal Infirmary                             408              57               16.2            262             6.7
  Greater Glasgow & Clyde Southern General Hospital, Glasgow                  152              34               15.3            60              0.9
  Greater Glasgow & Clyde Victoria Infirmary, Glasgow                         231              63               18.7            130             1.0
  Greater Glasgow & Clyde Western Infirmary, Glasgow                          351              144              17.1            112             0.4
  Greater Glasgow & Clyde Royal Alexandra Hospital, Paisley                   421              103              14.5            144             1.8
  Greater Glasgow & Clyde Inverclyde Hospital, Greenock                       216              80               15.0            84              1.4
  Greater Glasgow & Clyde NHS Greater Glasgow & Clyde                        1,779             481              16.2            792             3.0
  Highland                 Raigmore Hospital, Inverness                       325              27               19.5            219             2.9
  Highland                 NHS Highland                                       325              27               19.5            219             2.9
  Lanarkshire              Hairmyres Hospital                                 196              84               12.3            62              0.6
  Lanarkshire              Monklands Hospital                                 232              46               12.2            126             3.5
  Lanarkshire              Wishaw General Hospital                            290              46               12.5            156             1.4
  Lanarkshire              NHS Lanarkshire                                    718              176              12.3            344             2.0
Lothian                         Royal Infirmary of Edinburgh                              921                    287                    14.5                   417                     0.2
Lothian                         NHS Lothian                                               921                    287                    14.5                   417                     0.2
Tayside                         Ninewells Hospital, Dundee                                464                    187                    14.5                   130                     1.0
Tayside                         Perth Royal Infirmary                                     185                     42                    14.8                    83                     1.7
Tayside                         NHS Tayside                                               649                    229                    14.5                   213                     1.3
Total                                                      SCOTLAND                      6,540                  1,683                   15.2                  2,965                    2.0

A
  Source of data: Scottish Hip Fracture Audit Report 2008, and Rik Smith, Information Services Division (ISD). Available from url: www.shfa.scot.nhs.uk.
B
  Most patients who are discharged home before completion of the course of fondaparinux will need a home visit by a Community nurse to administer this. 'At home' days are based on actual days at
home in the first 28 days post surgery; calculated from review data for at least 90% of patients at each hospital except for RIE & ARI.
- RIE: no review data was collected in 2007, so home days for patients discharged straight home was calculated from a graph comparing the 'Balance of days at home' and actual number of days at
home. For patients home via rehab, 2003 data were used to calculate days at home because RIE patients had long rehab durations in 2003 relative to rest of Scotland.
- ARI data is based on data for Jan-Jun 2007 (no review data collected for July-Dec patients).
GRI, WIG, VI and SGH numbers are adjusted as no data collected in Jan. 2007. Crosshouse and Ayr numbers are adjusted to reflect that data collection did not begin until late Feb. 2007.
A small number of patients eg those who are discharged to other acute wards, have additional ' at home' days within the first 28 days post-surgery. No attempt has been made to include patients who
were not discharged either straight home or home via rehab.
A very small number of patients will have been included twice because SHFA includes patients for each fracture (i.e. one hip then the other). Approximately 0.5% of patients break their 'other' hip
within 28 days of the first, and few of these will have gone home within 28 days of either fracture, so this complication was considered very minor and not adjusted for.
             Costing summary for SIGN 111 Management of hip fracture in older people

                                                                   A national clinical guideline
STEP 2. Costing Template


        Select your Hospital or NHS Board in shaded Select Hospital or NHS Board cell of Step 1

                                                     Hospital or NHS Board: Select Hospital or NHS Board
        Left section                                                          Right section

Notes                  Selecting a shaded cell produces an explanation                               Shaded cells can be amended to reflect NHS board circumstances

        Patients receiving thromboprophylaxis using fondaprinux (section 5.5.3)

                                                                               Number of hip fractures
        Total number of cases                                                            0

                                                                                        Proportion                Number
        Patients without fondaparinux contraindication                                        95%                     0



        Days of thromboprophylaxis with fondaparinux                                           28

                                                                                                                  Total cost
        Fondaparinux                                                                      £6.66                      £0
        Total cost of thromboprophylaxis with fondaparinux                                                                                                                 £0

        Reduction in use of low molecular weight heparin and aspirin                 LMW Heparin                                             Aspirin

        Prescription                                                                          50%                                              50%


        Days of thromboprophylaxis                                                            8.5                                              8.5

                                                                                                                Total savings                Unit cost                Total savings

        Cost of drug                                                                      £4.20                      £0                       £0.02                        £0
        Total savings from reduced use of LMWH and aspirin                                                                                                                 £0

        Community nurse costs for patients going home direct or via Rehab           Straight Home                                          via Rehab

        Total number                                                                           0                                                 0



        Patients needing a nurse for injection                                                90%                                              90%



        Average number of home days                                                           0.00                                             0.00


                                                                                                                  Total cost                                            Total cost
        Cost for each visit by Community nurse for injection                              £24.00                     £0                       £24.00                       £0


        Total Community nurse costs for injection                                                                                                                          £0



        Risk reduction in incidence of symptomatic DVT                        Patients under 70 years old                           Patients over 69 years old         Total cost


                                                                                        Proportion                                          Proportion
        Cases                                                                             14.4%                                               85.6%


        Risk reduction                                                                        2.4%                                             2.4%


        Cost of Deep Vein Thrombosis                                                          £576                   £0                       £1,260                       £0

        Total savings from reduced risk of DVT                                                                                                                             £0

        Cost impact of fondaparinux                                                                                                                                        £0
        less Savings Impact of reduced use of LMWH and aspirin                                                                                                             £0
        Cost Impact of Community nurse for injection                                                                                                                       £0
        less Savings Impact from reduced risk of DVT                                                                                                                       £0

        Estimated cost of implementation for                                  Select Hospital or NHS Board                                                                 £0
                                          Management of hip fracture in older people

Cost of fully implementing recommendations nationally and for
                Select Hospital or NHS Board

A hospital or Health Board must be selected in STEP 1. Select Hospital, otherwise costs will only be provided at a national level.


Introduction
This document supports the implementation of the SIGN guideline 111

The costing template can be used to estimate both the national and local cost implications of implementing the guideline. By varying the assumptions and
entering in data in the shaded cells that reflect local circumstances, the local cost implications can be calculated.

How the costing template was developed

The development of the costing template for national and local use followed a structured approach which involved:


● carrying out background research into the appraisal content, current clinical practice, published information and available data.
● gathering expert opinion
● developing a costing model to be used to estimate the cost of implementation
● testing the model, including the assumptions and outcomes
● developing the template based on the costing model.

National costing summary

The total costs of implementing these recommendations across NHSScotland are estimated to be £1,728,000 per year. This includes the additional cost of
fondaparinux of £1,159,000 less savings on heparin and aspirin of £111,000; plus £680,000 for 28,000 extra home visits by a nurse for patients needing
injections after discharge.

£173,000 in hospital costs would be saved by the risk reduction in the incidence of symptomatic DVT from 2.7% to 0.3%, benefiting 149 patients. There would be
further savings post-discharge but these have not been quantified or costed.

Local costing summary

After adapting the assumptions in the costing template to reflect local circumstances including population, the estimated cost of implementing the
recommendations is summarised below.


Cost of implementing guidelines in Scotland                                        Scotland                                           Select Hospital or NHS Board

Recommendations
Cost impact of fondaparinux                                                      £1,158,600                                                                    £0
less Savings Impact of reduced use of LMWH and aspirin                            -£111,382                                                                    £0
Cost Impact of Community nurse for injection                                       £680,133                                                                    £0
less Savings Impact from reduced risk of DVT                                      -£173,194                                                                    £0
Total cost of recommendations                                                    £1,554,157                                                                    £0

Savings and Benefits


Apart from the DVT savings above, implementation of other recommendations, in particular those relating to multidisciplinary team working and supported
discharge schemes, should reduce acute hospital stay as well as leading to other patient and clinical benefits. These benefits have not been quantified or costed.
                                                  APPENDICES


Appendix 1: Report Development

Many thanks to all who have given their time, expertise and knowledge to inform the recommendations made
in this report. We would like to thank the members of the Guideline Development Group in particular for their
input and support:

Dr Colin Currie (Co-chair) Consultant Geriatrician, Astley Ainslie Hospital, Edinburgh
Professor James Hutchison (Co-chair) Regus Professor of Surgery, University of Aberdeen
Mr David Finlayson Orthopaedic Surgeon, Raigmore Hospital, Inverness
Dr Farida Hamza-Mohamed Programme Manager, SIGN
Dr David Ray Consultant Anaesthetist, Royal Infirmary of Edinburgh
Dr Damien Reid Consultant in Medicine for the Elderly, Hairmyres Hospital, East Kilbride
Mrs Lisa Stewart Occupational Therapy Lead Clinician, Astley Ainslie Hospital, Edinburgh
Dr Henry Watson Consultant Haematologist, Aberdeen Royal Infirmary

We are also very grateful to all of these experts for their contribution to this report:

Alberto Gregori Consultant Orthopaedic Surgeon Hairmyres Hospital, East Kilbride
Kathleen Duncan Clinical Coordinator, Scottish HIp Fracture Audit
Ewan Patterson Information Analyst NHS Resources Programme Information, ISD
Sandra Robb Programme Principle ISD
Kathy McGregor Senior Development Officer ISD
Rik Smith Information Analyst ISD
Brian Reid Principal Information Analyst ISD
Jackie Carrigan Head of Finance, Surgery & Anaesthetics Directorate NHS Greater Glasgow and Clyde
Frazer McCulloch Accountant, Surgery & Anaesthetics Directorate, NHS Greater Glasgow and Clyde
Christine Ashcroft Supported Discharge Manager, RAD Directorate NHS Greater Glasgow and Clyde
Lisa Wilson Health Economist, NHS Quality Improvement Scotland, Glasgow
Appendix 2 Clinical and Resource Impact assessment process

Stage 1: Draft Guideline at consultation stage

Stage 2: Identify the recommendations likely to have a significant resource impact

Stage 3: Identify key cost drivers for each significant recommendation and gather information required and
research clinical and cost evidence

Stage 4: Develop costing model – incorporate sensitivity analysis

Stage 5: Develop national clinical and resource impact report

Stage 6: Determine links between national and each board and develop cost template where required

Stage 7: Internal peer review with Guideline Chair and QIS

Stage 8: Circulate report and template to Guideline Group and others; update based on feedback and any
changes following consultations

Stage 9: Final sign-off

Stage 10: Publication, dissemination and impact assessment
Appendix 3 References

1 Scottish Intercollegiate Guidelines Network Management of hip fracture in older people: A national clinical
guideline. SIGN 111. 2009. Available from http://www.sign.ac.uk..
2 Managing the Financial Implications of NICE Guidance. Audit Commission 2005 http://www.audit-
commission.gov.uk/reports/NATIONALREPORT. asp?CategoryID=&ProdID=CC53DDFE-42C8-49c7-BB53-
9F6485262718
3 Developing costing tools; Methods guide. NICE January 2008
http://www.nice.org.uk/media/F3E/57/DevelopingCostingToolsMethodsGuide.pdf
4 Trueman P, Hutton J, Drummond M. Developing Guidance for Budget Impact Analysis.
Pharmacoeconomics, 19(6): 609-621, 2001.
5 Mauskopf J. et al. Principles of Good Practice for Budget Impact Analysis: Report of the ISPOR Task
Force on Good Research Practice: Budget Impact Analysis. Value in Health, 10(5): 336-347, 2007.
6 Trueman P., Cardow T. Independent Evaluation of the Resource Impact Tools Developed Alongside the
SIGN CHD Guidelines. York Health Economics Consortium March 2008.
7 Scottish Hip Fracture Audit Report Information Services Division (ISD); 2008. Available from url:
www.shfa.scot.nhs.uk
8 Lawrence T, White CT, Wenn R, Moran CG. The current hospital costs of treating hip fractures. Injury
2005;36((1)):88-91.
9 Personal communication from Frazer McCulloch, NHS Greater Glasgow & Clyde
Management of hip fracture in older people

Where to find the guidelines?

You can download the following documents from

Scottish Intercollegiate Guidelines Network (SIGN)
http://www.sign.ac.uk/guidelines/fulltext/111/index.html

SIGN 111 A national clinical guideline. May 2009
Management of hip fracture in older people


Comments and feedback on the usefulness of this costing template are welcome
and can be e-mailed to:


George English                          Lisa Wilson
Senior Project Cost Accountant          Health Economist
NHS Quality Improvement Scotland        NHS Quality Improvement Scotland
Delta House                             Delta House
7th Floor Delta House                   7th Floor Delta House
50 West Nile Street                     50 West Nile Street
Glasgow                                 Glasgow
G1 2NP                                  G1 2NP
0141 227 3278                           0141 225 6889
www.nhshealthquality.org/nhsqis         www.nhshealthquality.org/nhsqis
george.english@nhs.net                  lisa.wilson3@nhs.net

				
DOCUMENT INFO
Description: Template for Executive Summary document sample