High expenditure diseases and interventions Variation of inpatient expenditure rates

2 Cancer

3 Cancer – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) There is a 2-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 14.1%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £100M (if PCTs with rates higher than the median reduced to this level). London

4 Circulation

5 There is a 3-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 17.6%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £138M (if PCTs with rates higher than the median reduced to this level). Circulatory diseases – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London

6 Cardiac valve procedures – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Some overlap with circulatory 96% of expenditure in analysis Cardiac valve procedures cost £12,343 each. There is a 5-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 26.5%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £19M (if PCTs with rates higher than the median reduced to this level). Relatively high unwarranted variation so large potential savings. Small drops in activity give large savings

7 Percutaneous coronary intervention – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Percutaneous coronary interventions cost £4,582 each. There is a 4-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 29.5%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £32M (if PCTs with rates higher than the median reduced to this level). Relatively high unwarranted variation so large potential savings.

8 Cardiac catheterisation and angiography – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Cardiac catheterisation and angiography without complications cost £1,901 each. There is a 5-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 29.9%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £28M (if PCTs with rates higher than the median reduced to this level).

9 Coronary bypass – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Coronary bypasses cost £8,660 each. There is a 9-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 27.3%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £14M (if PCTs with rates higher than the median reduced to this level).

10 Non-transient stroke or cerebrovascular accident >69 Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Non-transient stroke or cerebrovascular accidents >69 cost £4,096 each. There is a 5-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 18.7%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £14M (if PCTs with rates higher than the median reduced to this level).

11 Musculoskeletal

12 Musculoskeletal problems – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London We are working on disease specific additional needs, which will even better adjust rates across the country Much variation is also above the median, so leads to large potential savings There is a 3-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 20.3%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £163M (if PCTs with rates higher than the median reduced to this level).

13 Primary knee replacements – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Primary knee replacements cost £5,806 each. There is a 4-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 20.6%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £38M (if PCTs with rates higher than the median reduced to this level).

14 Primary Hip Replacement Cemented – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Primary hip replacement cemented cost £5,467 each. There is a 15-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 39.9%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £41M (if PCTs with rates higher than the median reduced to this level). Extremely large variation between PCTs. Relatively large unwarranted variation so large potential savings

15 Complex Elderly with a Musculoskeletal System Primary Diagnosis Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Complex elderly with a musculoskeletal system primary diagnosis cost £6,927 each. There is a 3-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 21.3% (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £21M (if PCTs with rates higher than the median reduced to this level).

16 Respiratory

17 Respiratory diseases – Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Accounting for additional needs explains much variation between PCTs There is a 2-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 11.4%. (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £57M (if PCTs with rates higher than the median reduced to this level). Relatively little unwarranted variation so small potential savings

18 Complex Elderly with a Respiratory System Primary Diagnosis Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Complex elderly with a respiratory system primary diagnosis cost £3,165 each. There is a 4-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 24.2% (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £20M (if PCTs with rates higher than the median reduced to this level).

19 Interventions not in above categories

20 Complex Elderly with a Nervous System Primary Diagnosis Inpatient expenditure rate, 2008/9 (weighted for age, sex and need - per 1,000 population). Source: DH CAI (using HES) London Complex elderly with a nervous system primary diagnosis cost £5,401 each. There is a 4-fold variation in expenditure between PCTs (adjusting for age, sex and need). The coefficient of variation is 23.6% (This takes into account all PCTs, not just the top and bottom PCTs.) The potential savings are £15M (if PCTs with rates higher than the median reduced to this level).