Staying in Work with a Long-term condition: The value of medical technologies
15 November 2011
As the UK workforce ages and the burden of chronic diseases in the wider population grows it is clear that access to medical interventions which help people to stay in work will become more important – both economically and socially.
Today we were very proud to launch the Work Foundation’s new report Adding value: Assessing the economic and societal benefits of medical technologies at a meeting of the All Party Parliamentary Group (APPG) on Improving Patient Access to Medical Technology in the House of Commons. This study gathered evidence that is set to challenge the current model of assessment of medical technologies in the UK.
The current schedule of assessment by NICE focuses mainly on the clinical outcomes associated with medical interventions, such as changes in rates of accident and emergency admissions, extended longevity and prolonged health-related quality of life. In the report we argue that such a perspective is very short-sighted as individuals’ health status impacts mid-term and long-term outcomes for households, healthcare system and wider society.
One of the factors that is often not assessed with regard to medical technologies is the extent to which a particular intervention supports individual ‘workability’ and continued active participation in the labour market. Our research shows very clearly that staying at work or being able to return to work also matters a great deal for a range of other stakeholders, including families, carers, employers, co-workers, and - at the macro level – taxpayers, carrying the burden of social care and welfare. Ultimately, delayed or ineffective intervention leads to skill gaps, early retirement due to disability and poor economic sustainability of the state.
Our report considers the impact of three medical technologies: artificial hip and knee replacements, implantable cardioverter defibrillators and insulin pumps, all of which may offer extended societal benefits beyond those currently considered in the health technology assessment (HTA) agenda.
For example, artificial hip/knee replacements prevent disability and allow patients to keep their jobs – 31 per cent of women and 42 per cent of men receiving an artificial hip are of working age. In 2009 approximately 11,000 people in England and Wales were helped to return to work by hip replacement surgery, saving the UK welfare system £37.4 million per year for the remainder of their working lives.
Implantable cardioverter-defibrillators (ICDs) offer crucial advantages by extending lives of people with heart conditions who may be at risk of sudden cardiac death. ICDs can be regarded as an insurance policy for those known to be at high risk , as the device has been shown to prevent death from sudden cardiac arrest in 98 per cent of cases. Return to work following implantation of an Implantable Cardioverter Defibrillator (ICD) reduces the burden to the UK welfare system by £4.6million each year. If the number of people given access to ICDs was to match the European rate, the savings would increase to £6.8 million a year.
Insulin pump therapy provides greater lifestyle flexibility (including that of relevance to working life) and reduces risk of diabetes complications through improved control over blood glucose levels. Insulin pumps have been shown to support cognitive development and improved psychological adjustment of young patients, justifying the possibility of early use of the intervention among children. If the number of insulin pump users was brought up by 7 per cent to reach the 12 per cent benchmark set by NICE, additional savings just on consultant’ visits and hospital admissions would add up to between £37.2 million and £62.5 million per year. With the prevalence of diabetes set to increase by 188 per cent by 2030, it will be important to ensure that people of working age with this condition are supported in their efforts to stay well and to participate fully in the labour market.
The NHS outcomes framework now includes work as an important clinical outcome of treatment for people with long-term conditions. However, to help people stay in or return to work, appropriate treatment needs to be made more readily available to the individuals who may benefit from it.
One of the other main conclusions of our research is that health technology assessment processes should be permitted to consider the bigger picture of the wider societal value of medical interventions. It is important to view a patient as an individual who plays a role within wider society rather than a voiceless patient subject to clinical procedures, and the health technology assessment process must reflect that approach.