Aneel Bhangu: Surgical energy devices in the #NHS - time for 'value surgery'?

Aneel Bhangu: Surgical energy devices in the #NHS – time for ‘value surgery’?

Four known facts:

1. Most surgeons either don’t know the cost of the equipment they use or work in systems with vastly differing costs. Our survey on the known costs of a PDS suture, and responses, show this:

2. For energy devices used in laparoscopic surgery, there is a huge range of costs in the #NHS. The upper limit has been shown at £2473 and the lower limit at £28. This lower limit is probably wrong or relates to something different (e.g. diathermy hook). An average cost might be around £500.

3. Taking figures from 2017/2018 NHS practice (England), there 22,774 elective colorectal resections (8247 right hemicolectomy, 2458 sigmoid colectomy, 1181 total colectomy, 1681 abdominoperineal resections, 9167 anterior resection). Assuming two thirds of these are laparoscopic, and 80% of those utilise an energy device, 11,047 energy devices per year are used in elective colorectal surgery in the NHS.

4. There is ample evidence to show that there is very little difference between modern energy devices in experienced hands:

https://www.ncbi.nlm.nih.gov/pubmed/27420752

https://www.ncbi.nlm.nih.gov/pubmed/29870293

https://www.ncbi.nlm.nih.gov/pubmed/21563161

So in this type of surgery alone, reducing costs is likely to bring major benefit to the NHS. Reducing the cost per device by an average of £100 will create an annual saving of £1.1million, for just colorectal surgery. This model would allow surgeons/hospitals to still utilise whichever device they wanted, but would lead to better value for patients and taxpayers. Balancing the minimum cost will also improve acceptability to industry.

Energy devices are used as an example here, with multiple other devices and instruments against which to leverage value.

Value surgery – the NHS is a world leading example of a Universal Health Coverage system. Value surgery will become important across the NHS and the world. It is a combination term of clinical effectiveness, cost, and efficiency – more on these in the future.