How Specials Can Deliver Value to the NHS | Page 9

Please refer to Assessing clinical need on page 6.

Cost-effectiveness and quality of life improvements
Clearly in this case had rapid action not been taken and a suitable unlicensed
Special dispensed, the patient may have lost their eyesight. It is difficult to
cost blindness but it is fair to assume that over a lifetime, an intervention
which had prevented this loss of sight will offer a cost-effective approach to
the patient need. There may also have been a need for an in-patient stay and
ocular surgery at some stage. A non-surgical ophthalmology NHS tariff with a
length of stay of two days or more is costed as £2,38512, according to the 201314 tariff (admitted patient care & outpatient procedures7). The full cost of lifetime blindness is difficult to quantify13. The cost of the first year of blindness
was found to be approximately £6,45513. In the second and subsequent years
of blindness this figure fell to £6,295 per year13. These costs were calculated
in 2003 so would be significantly higher in 2014. This puts into context the
value an unlicensed Special can offer, supplied to the correct patient, when
no licensed alternative is available. Clearly, if a product had not been available,
the patient could have lost their sight and faced a significant deterioration
in their quality of life. A significant lifetime cost would have been incurred to
support the sight-impaired patient, including potential disability support/
lifetime loss of earnings.
The quality of life is also likely to be significantly better with retained vision.
The quality-adjusted life year (QALY) is likely to remain around 0.8-1.0 rather
than fall to 0.6 or below if the patient had lost their sight14. DALYs (disability
adjusted life years) are also significantly improved if blindness is prevented14.

CASE STUDY 1

Assessing clinical need

Patient with an
allergy to an eye
drop preservative

Many patients with loss of eyesight/impaired insight also become
depressed14. This is not surprising and again depression has significant costs,
as well as impairing quality of life.
Indirect costs attributable to a poor outcome, without the use of the
unlicensed Special, could potentially include loss of productivity, lower
employment, absenteeism, premature mortality and informal care costs14.

12. 2013-14 tariff – admitted patient care & outpatient procedures – BZ24A-01. APC & OPROC [date accessed 18/02/14]
13. The British Journal of Ophthalmology (BJO) 2003;87:1201-1204 http://bjo.bmj.com/content/87/10/1201.full [date accessed 18/02/14]
14. The economic impact of partial sight and blindness in the UK adult population, RNIB 2010 report,
https://www.google.co.uk/?gws_rd=cr&ei=Z0EGU53-FvKrsAS5wICYCQ#q=QALY+lost+sight+uk [date accessed 20/02/14]

9