Cost of Mis-Diagnosis
Failure to recognise B12 deficiency may be costing the country billions of pounds in lost tax, lost quality of life, and costs to the NHS. As only the costs to the NHS can be calculated with any accuracy, let's look at these.
For the purposes of the calculations we’ve used the 2007/08 census and prevalence figures, and only used the number of patients suffering from specific named conditions, i.e. 2 million, so the actual benefits may be much higher.
In simple terms, the cost of screening 2 million people from B12 deficiency would be around £6.7 million (one off cost), and assuming that 30% of these required injections and the rest oral tablets, treatment costs would be £118.3 million per year.
This would save at least £854 million per year, specifically on medication costs to the NHS (i.e. not including social services or care costs and all of the other more nebulous costs), and even then we've excluded a lot of savings which we considered "too difficult to estimate" so this is a very conservative figure. This only represents around 5% of the total NHS medicines budget, which is reassuring considering the number of patients being treated (perhaps around 15% of the "active patients").
Vitamin B12 deficiency symptoms are common witha number of other conditions, some of which may share these symptoms simply because they are caused by deficiency of this important vitamin. Many diseases are a description of the symptoms, not of the potential cause.
Some treatment prescribed for these mis-diagnosed conditions may at best stabilise the condition and reduce side effects. Misdiagnosis can be dangerous – during the September 2009 Swine Flu crisis, at least one person nearly died from meningitis because they were diagnosed with swine flu and treated for the wrong thing.
Most people want to get better, and where the symptoms can be relieved by Vitamin B12 replacement therapy this may even lead to the physician declaring the condition ‘resolved’ (the disease cured).
Misdiagnosis has a cost.
There’s a cost to the person suffering, their carers and friends, their employer, and society. Depression, lack of self-worth, neuroses, days lost sick because nothing seems to work. Pain, fatigue and inability to work. These are very real to the sufferer, but I won’t try to quantify them because
1. it’s very easy to come up with valuations that, whilst fully justified, start to look too big to be believable for policy-makers
2. it’s insulting to put a low value on pain, and difficult to put a high one
Cost to NHS and social care
Let’s look at the direct and measurable NHS costs of some commonly diagnosed conditions which could be Vitamin B12 deficiency :
Although figures are given for renal disfunction and diabetes, there are so many causes for these conditions that their figures are not included in any totals. For the other conditions only a proportion of the figures are included
Pernicious anaemia (PA) – PRIMIS+ (an analysis system based on MIQUEST data, developed by NHS Information Centre and Connecting for Health and hosted by University of Nottingham) records 190,073 people diagnosed with PA and 251,555 receiving injections of hydroxocobalamin (usually only administered with a diagnosis of PA). The cost of administering hydroxocobalamin (a manufactured form of B12) is approx £10 per injection (representing £1.50 for the medication and a charge for nursing time) at a frequency of one per 3 months = £10,062,200. Of course this doesn’t include any care needs such as special diets, home care support, nor any of the social costs.
Total cost to NHS (see above) (£million)
Proportion of total cost used for calculation
National cost figure used (see above) (£million)
|Crohns and IBS||230||
|ME/CFS/Fibromyalgia and other fatigue||59||80%||48|
|Dementia, Alzheimers||1,362 + estimate for Social Services||50%||681|
|Multiple Sclerosis||Not possible to calculate||Costs Not included||Costs Not included|
|Renal disfunction, Chronic Kidney Disease||91 (primary care excluding GMS & Public Health)||Costs Not included||Costs Not included|
|Diabetes||9,000||Costs Not included||Costs Not included|
£854,000,000. £0.8billion. This figure is a conservative estimate in a population of 54million (2007/08 census which is the date for most of the prevalence data). It’s also big in terms of numbers of people suffering:
- 75,000 with Crohns/IBS.
- 75,000 with ME/CFS and perhaps 10x this number with all forms of fatigue.
- 574,000 with dementia.
- 251,000 receiving treatment for PA (whether diagnosis recorded or not)
- Millions with renal imbalance and diabetes.
The numbers are huge. Lets put a round number on it, say 2million.
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