Guide

A costing report (word document) that provides a summary of the guidance and provides some background on the
assumptions used in the costing model is also available on the NICE website. The report also highlights further factors
that should be considered when using this template.

Within the assumptions input and unit costs sheets, cells highlighted in light blue are unlocked to allow users to make
adjustments to the model.
The population and cost summary allows the user to select the population to be used in the model and displays the
estimated cost impact of implementing the guidance for the selected population. Select the population(s) and appropriate
proportions from the drop down boxes in columns B, C and D. If no changes are made on this sheet, the template will
default to a population of 100,000.

Population & Cost

Summary

The cost impact for the selected population(s) is displayed in column E.

The assumptions input worksheet allows the user to amend the assumptions in the template to take account of local
circumstances. Several assumptions have been made to produce this costing template, based on national data and the
view of clinical specialists advising NICE. However, we recognise that these assumptions may not accurately reflect local
circumstances. Therefore, users can input their own assumptions in the light blue cells.

Assumptions input

Any number and combination of the assumptions can be changed. To revert to the NICE assumptions delete your input
and either leave the cell blank or input a '-'. If no assumptions are made, the standard assumptions will be used. The
diagram shows how the assumptions affect the population, and calculates the volume of activity to be used in the costing
template.

The costing template worksheet shows the financial impact of the guidance based on the population selected and the
assumptions made.
The first column of calculations shows the resource impact using the selected population and the standard NICE
assumptions. The second column shows the resource impact using the selected population and any local assumptions
that have been made.

The unit costs worksheet allows users to see how the unit costs used in this template have been calculated. You can use
Table 2 for local input to amend in line with local assumptions.

The sensitivity analysis demonstrates the extent to which fluctuations in the variables will affect the overall cost of
implementing the guidance. The sensitivity analysis considers the impact of fluctuations of individual variables.

Costing template

Unit costs

Sensitivity analysis

The sensitivity analysis is independent of the input sheet and the costing template, and should be used to inform users
about the sensitivity of the costs to changes in the standard NICE assumptions.

The references and data sources worksheet lists references and sources used to inform the costing template. The
reference numbers relate to the source numbers listed on the assumptions input worksheet and are hyperlinked to the
appropriate reference.

The costs over time worksheet includes, where appropriate, estimates of uptake and cost impact over a period of years.
You can amend cells highlighted in blue to reflect local assumptions.
The costing template was developed using a structured approach. This involved:
background research into the guidance content, current practice, published information and available data
gathering expert opinion
developing a costing model to estimate the cost of implementation
testing the model, including the assumptions and outcomes
developing the template and report based on the costing model.

National Institute for Health and Care Excellence, 2015. All rights reserved. This material may be freely reproduced for
educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes,
is allowed without the express written permission of NICE.

References and data

sources

Costs over time

Rivaroxaban for acute coronary syndrome

Population and Cost Summary

Organisation type

Organisation

Per 100,000 Population

Per 100,000 population

<manual input>

Total cost impact

Proportion

Total Population
100%

78,604

16,065

Population data

Organisation
Per 100,000 population
<manual input>
TOTAL - to be used in sheet 6

Total population

Percentage of population
Males aged 18 and over
Females aged 18 and over to be used
Males aged 18 and over
Females aged 18 and over
38,237
40,367
100%
38,237
40,367
100%
100,000
38,237
40,367
38,237
40,367
100,000

2014-15 tariff - market forces factor (MFF)

Delete or hide if appropriate

Provider Code

Provider Name

Type

Payment index
value for 201415

RTQ

2GETHER NHS FOUNDATION TRUST

Trust

1.0607

RTV

5 BOROUGHS PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0456

REM

AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Trust

1.0387

RCF

AIREDALE NHS FOUNDATION TRUST

Trust

1.0305

RBS

ALDER HEY CHILDREN'S NHS FOUNDATION TRUST

Trust

1.0399

RTK

ASHFORD AND ST. PETER'S HOSPITALS NHS FOUNDATION TRUST

Trust

1.1700

RVN

AVON AND WILTSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST

Trust

1.0747

RF4

BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST

Trust

1.1744

RVL

BARNET AND CHASE FARM HOSPITALS NHS TRUST

Trust

1.1973

RRP

BARNET, ENFIELD AND HARINGEY MENTAL HEALTH NHS TRUST

Trust

1.2003

RFF

BARNSLEY HOSPITAL NHS FOUNDATION TRUST

Trust

1.0323

R1H

BARTS HEALTH NHS TRUST

Trust

1.2128

RDD

BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

Trust

1.1228

RC1

BEDFORD HOSPITAL NHS TRUST

Trust

1.0887

RWX

BERKSHIRE HEALTHCARE NHS FOUNDATION TRUST

Trust

1.1504

RXT

BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST

Trust

1.0453

RQ3

BIRMINGHAM CHILDREN'S HOSPITAL NHS FOUNDATION TRUST

Trust

1.0516

RYW

BIRMINGHAM COMMUNITY HEALTHCARE NHS TRUST

Trust

1.0567

RLU

BIRMINGHAM WOMEN'S NHS FOUNDATION TRUST

Trust

1.0439

TAJ

BLACK COUNTRY PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0392

RXL

BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST

Trust

1.0265

RMC

BOLTON NHS FOUNDATION TRUST

Trust

1.0480

TAD

BRADFORD DISTRICT CARE TRUST

Trust

1.0339
1.0337

RAE

BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST

Trust

RY2

BRIDGEWATER COMMUNITY HEALTHCARE NHS TRUST

Trust

1.0411

RXH

BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST

Trust

1.0744

RXQ

BUCKINGHAMSHIRE HEALTHCARE NHS TRUST

Trust

1.1442

RJF

BURTON HOSPITALS NHS FOUNDATION TRUST

Trust

1.0397

RWY

CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST

Trust

1.0389

RJX

CALDERSTONES PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0286

RGT

CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

Trust

1.0885

RT1

CAMBRIDGESHIRE AND PETERBOROUGH NHS FOUNDATION TRUST

Trust

1.0773

RYV

CAMBRIDGESHIRE COMMUNITY SERVICES NHS TRUST

Trust

1.0927

TAF

CAMDEN AND ISLINGTON NHS FOUNDATION TRUST

Trust

1.2232

RV3

CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST

Trust

1.2141

RYX

CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST

Trust

1.2313

RW3

CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

Trust

1.0568

RQM

CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST

Trust

1.2939

RXA

CHESHIRE AND WIRRAL PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0425

RFS

CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST

Trust

1.0289

RLN

CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST

Trust

1.0263

RDE

COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST

Trust

1.0547

RJ8

CORNWALL PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0000

RJR

COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST

Trust

1.0409

RXP

COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST

Trust

1.0278

RYG

COVENTRY AND WARWICKSHIRE PARTNERSHIP NHS TRUST

Trust

1.0545

RJ6

CROYDON HEALTH SERVICES NHS TRUST

Trust

1.2045

RNN

CUMBRIA PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0266

RN7

DARTFORD AND GRAVESHAM NHS TRUST

Trust

1.1577

RTG

DERBY HOSPITALS NHS FOUNDATION TRUST

Trust

1.0400

RY8

DERBYSHIRE COMMUNITY HEALTH SERVICES NHS TRUST

Trust

1.0321

RXM

DERBYSHIRE HEALTHCARE NHS FOUNDATION TRUST

Trust

1.0333

RWV

DEVON PARTNERSHIP NHS TRUST

Trust

1.0165

RP5

DONCASTER AND BASSETLAW HOSPITALS NHS FOUNDATION TRUST

Trust

1.0359

RBD

DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST

Trust

1.0474

RDY

DORSET HEALTHCARE UNIVERSITY NHS FOUNDATION TRUST

Trust

1.0656

RYK

DUDLEY AND WALSALL MENTAL HEALTH PARTNERSHIP NHS TRUST

Trust

1.0369

RC3

EALING HOSPITAL NHS TRUST

Trust

1.1992

RWH

EAST AND NORTH HERTFORDSHIRE NHS TRUST

Trust

1.1405

RJN

EAST CHESHIRE NHS TRUST

Trust

1.0493

RVV

EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST

Trust

1.0455

RXR

EAST LANCASHIRE HOSPITALS NHS TRUST

Trust

1.0325

RWK

EAST LONDON NHS FOUNDATION TRUST

Trust

1.2178

RX9

EAST MIDLANDS AMBULANCE SERVICE NHS TRUST

Trust

1.0407

RYC

EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST

Trust

1.0786

RXC

EAST SUSSEX HEALTHCARE NHS TRUST

Trust

1.0441

RVR

EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST

Trust

1.1922

RDU

FRIMLEY PARK HOSPITAL NHS FOUNDATION TRUST

Trust

1.1617

RR7

GATESHEAD HEALTH NHS FOUNDATION TRUST

Trust

1.0282

RLT

GEORGE ELIOT HOSPITAL NHS TRUST

Trust

1.0507

R1J

GLOUCESTERSHIRE CARE SERVICES NHS TRUST

Trust

1.0620

RTE

GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST

Trust

1.0571

RP4

GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST

Trust

1.2858

RN3

GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST

Trust

1.0952

RXV

GREATER MANCHESTER WEST MENTAL HEALTH NHS FOUNDATION TRUST

Trust

1.0502

RJ1

GUY'S AND ST THOMAS' NHS FOUNDATION TRUST

Trust

1.2770

RN5

HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST

Trust

1.1096

RCD

HARROGATE AND DISTRICT NHS FOUNDATION TRUST

Trust

1.0393

RR1

HEART OF ENGLAND NHS FOUNDATION TRUST

Trust

1.0490

RD7

HEATHERWOOD AND WEXHAM PARK HOSPITALS NHS FOUNDATION TRUST

Trust

1.1687

RY4

HERTFORDSHIRE COMMUNITY NHS TRUST

Trust

1.1349

RWR

HERTFORDSHIRE PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST

Trust

1.1448

RQQ

HINCHINGBROOKE HEALTH CARE NHS TRUST

Trust

1.0797

RQX

HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Trust

1.2052

RY9

HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST

Trust

1.1794

RWA

HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST

Trust

1.0155

RV9

HUMBER NHS FOUNDATION TRUST

Trust

1.0187

RYJ

IMPERIAL COLLEGE HEALTHCARE NHS TRUST

Trust

1.2417

RGQ

IPSWICH HOSPITAL NHS TRUST

Trust

1.0449

R1F

ISLE OF WIGHT NHS TRUST

Trust

1.0511

RGP

JAMES PAGET UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

Trust

1.0187

RXY

KENT AND MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST

Trust

1.0974

RYY

KENT COMMUNITY HEALTH NHS TRUST

Trust

1.0733

RNQ

KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST

Trust

1.0543

RJZ

KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST

Trust

1.2132

RAX

KINGSTON HOSPITAL NHS FOUNDATION TRUST

Trust

1.2075

RW5

LANCASHIRE CARE NHS FOUNDATION TRUST

Trust

1.0314

RXN

LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST

Trust

1.0354

RGD

LEEDS AND YORK PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0401

RY6

LEEDS COMMUNITY HEALTHCARE NHS TRUST

Trust

1.0503

RR8

LEEDS TEACHING HOSPITALS NHS TRUST

Trust

1.0461

RT5

LEICESTERSHIRE PARTNERSHIP NHS TRUST

Trust

1.0432

RJ2

LEWISHAM AND GREENWICH NHS TRUST

Trust

1.2043

RY5

LINCOLNSHIRE COMMUNITY HEALTH SERVICES NHS TRUST

Trust

1.0155

RP7

LINCOLNSHIRE PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0160

RY1

LIVERPOOL COMMUNITY HEALTH NHS TRUST

Trust

1.0440

RBQ

LIVERPOOL HEART AND CHEST HOSPITAL NHS FOUNDATION TRUST

Trust

1.0418

REP

LIVERPOOL WOMEN'S NHS FOUNDATION TRUST

Trust

1.0405

RRU

LONDON AMBULANCE SERVICE NHS TRUST

Trust

1.1965

RC9

LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Trust

1.1203

RWF

MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST

Trust

1.1095

TAE

MANCHESTER MENTAL HEALTH AND SOCIAL CARE TRUST

Trust

1.0565

RPA

MEDWAY NHS FOUNDATION TRUST

Trust

1.1016

RW4

MERSEY CARE NHS TRUST

Trust

1.0386

RBT

MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST

Trust

1.0437

RQ8

MID ESSEX HOSPITAL SERVICES NHS TRUST

Trust

1.0992

RJD

MID STAFFORDSHIRE NHS FOUNDATION TRUST

Trust

1.0349

RXF

MID YORKSHIRE HOSPITALS NHS TRUST

Trust

1.0406

RD8

MILTON KEYNES HOSPITAL NHS FOUNDATION TRUST

Trust

1.1061

RP6

MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST

Trust

1.2646

RM1

NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST

Trust

1.0153

RMY

NORFOLK AND SUFFOLK NHS FOUNDATION TRUST

Trust

1.0253

RY3

NORFOLK COMMUNITY HEALTH AND CARE NHS TRUST

Trust

1.0193

RVJ

NORTH BRISTOL NHS TRUST

Trust

1.0785

RNL

NORTH CUMBRIA UNIVERSITY HOSPITALS NHS TRUST

Trust

1.0286

RX6

NORTH EAST AMBULANCE SERVICE NHS FOUNDATION TRUST

Trust

1.0300

RAT

NORTH EAST LONDON NHS FOUNDATION TRUST

Trust

1.1729

RRD

NORTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST

Trust

1.0865

RAP

NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST

Trust

1.2012

RLY

NORTH STAFFORDSHIRE COMBINED HEALTHCARE NHS TRUST

Trust

1.0236

RVW

NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST

Trust

1.0248

RX7

NORTH WEST AMBULANCE SERVICE NHS TRUST

Trust

1.0467

RV8

NORTH WEST LONDON HOSPITALS NHS TRUST

Trust

1.1954

RNS

NORTHAMPTON GENERAL HOSPITAL NHS TRUST

Trust

1.0611

RP1

NORTHAMPTONSHIRE HEALTHCARE NHS FOUNDATION TRUST

Trust

1.0575

RBZ

NORTHERN DEVON HEALTHCARE NHS TRUST

Trust

1.0194

RJL

NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST

Trust

1.0251

RX4

NORTHUMBERLAND, TYNE AND WEAR NHS FOUNDATION TRUST

Trust

1.0294

RTF

NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST

Trust

1.0300

RX1

NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST

Trust

1.0387

RHA

NOTTINGHAMSHIRE HEALTHCARE NHS TRUST

Trust

1.0324

RNU

OXFORD HEALTH NHS FOUNDATION TRUST

Trust

1.1106

RTH

OXFORD UNIVERSITY HOSPITALS NHS TRUST

Trust

1.1003

RPG

OXLEAS NHS FOUNDATION TRUST

Trust

1.1777

RGM

PAPWORTH HOSPITAL NHS FOUNDATION TRUST

Trust

1.0802

RW6

PENNINE ACUTE HOSPITALS NHS TRUST

Trust

1.0489

RT2

PENNINE CARE NHS FOUNDATION TRUST

Trust

1.0513

RGN

PETERBOROUGH AND STAMFORD HOSPITALS NHS FOUNDATION TRUST

Trust

1.0602

RK9

PLYMOUTH HOSPITALS NHS TRUST

Trust

1.0158

RD3

POOLE HOSPITAL NHS FOUNDATION TRUST

Trust

1.0666

RHU

PORTSMOUTH HOSPITALS NHS TRUST

Trust

1.0890

RPC

QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST

Trust

1.1429

RXE

ROTHERHAM DONCASTER AND SOUTH HUMBER NHS FOUNDATION TRUST

Trust

1.0343

RHW

ROYAL BERKSHIRE NHS FOUNDATION TRUST

Trust

1.1498

RT3

ROYAL BROMPTON & HAREFIELD NHS FOUNDATION TRUST

Trust

1.2532
1.0032

REF

ROYAL CORNWALL HOSPITALS NHS TRUST

Trust

RH8

ROYAL DEVON AND EXETER NHS FOUNDATION TRUST

Trust

1.0211

RAL

ROYAL FREE LONDON NHS FOUNDATION TRUST

Trust

1.2465

RQ6

ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST

Trust

1.0422

RBB

ROYAL NATIONAL HOSPITAL FOR RHEUMATIC DISEASES NHS FOUNDATION TRUST

Trust

1.1004

RAN

ROYAL NATIONAL ORTHOPAEDIC HOSPITAL NHS TRUST

Trust

1.1800

RA2

ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST

Trust

1.1600

RD1

ROYAL UNITED HOSPITAL BATH NHS TRUST

Trust

1.0805

RM3

SALFORD ROYAL NHS FOUNDATION TRUST

Trust

1.0560

RNZ

SALISBURY NHS FOUNDATION TRUST

Trust

1.0703

RXK

SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST

Trust

1.0406

RCU

SHEFFIELD CHILDREN'S NHS FOUNDATION TRUST

Trust

1.0327

TAH

SHEFFIELD HEALTH & SOCIAL CARE NHS FOUNDATION TRUST

Trust

1.0305

RHQ

SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST

Trust

1.0294

RK5

SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST

Trust

1.0314

RXW

SHREWSBURY AND TELFORD HOSPITAL NHS TRUST

Trust

1.0263

R1D

SHROPSHIRE COMMUNITY HEALTH NHS TRUST

Trust

1.0325

R1C

SOLENT NHS TRUST

Trust

1.0922

RH5

SOMERSET PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0357

RYE

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST

Trust

1.1183

RA9

SOUTH DEVON HEALTHCARE NHS FOUNDATION TRUST

Trust

1.0136

RYD

SOUTH EAST COAST AMBULANCE SERVICE NHS FOUNDATION TRUST

Trust

1.0946

RWN

SOUTH ESSEX PARTNERSHIP UNIVERSITY NHS FOUNDATION TRUST

Trust

1.1099

RV5

SOUTH LONDON AND MAUDSLEY NHS FOUNDATION TRUST

Trust

1.1945

RRE

SOUTH STAFFORDSHIRE AND SHROPSHIRE HEALTHCARE NHS FOUNDATION TRUST

Trust

1.0315

RTR

SOUTH TEES HOSPITALS NHS FOUNDATION TRUST

Trust

1.0292

RE9

SOUTH TYNESIDE NHS FOUNDATION TRUST

Trust

1.0294

RJC

SOUTH WARWICKSHIRE NHS FOUNDATION TRUST

Trust

1.0565

RQY

SOUTH WEST LONDON AND ST GEORGE'S MENTAL HEALTH NHS TRUST

Trust

1.2007

RXG

SOUTH WEST YORKSHIRE PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0371

RYF

SOUTH WESTERN AMBULANCE SERVICE NHS FOUNDATION TRUST

Trust

1.0485
1.0782

RAJ

SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST

Trust

RW1

SOUTHERN HEALTH NHS FOUNDATION TRUST

Trust

1.0911

RVY

SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST

Trust

1.0361

RJ7

ST GEORGE'S HEALTHCARE NHS TRUST

Trust

1.2125

RBN

ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST

Trust

1.0431

R1E

STAFFORDSHIRE AND STOKE ON TRENT PARTNERSHIP NHS TRUST

Trust

1.0327

RWJ

STOCKPORT NHS FOUNDATION TRUST

Trust

1.0573

RXX

SURREY AND BORDERS PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.1714

RTP

SURREY AND SUSSEX HEALTHCARE NHS TRUST

Trust

1.1647

RDR

SUSSEX COMMUNITY NHS TRUST

Trust

1.0703

RX2

SUSSEX PARTNERSHIP NHS FOUNDATION TRUST

Trust

1.0771

RMP

TAMESIDE HOSPITAL NHS FOUNDATION TRUST

Trust

1.0523

RBA

TAUNTON AND SOMERSET NHS FOUNDATION TRUST

Trust

1.0297

RNK

TAVISTOCK AND PORTMAN NHS FOUNDATION TRUST

Trust

1.2383

RX3

TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST

Trust

1.0265

RBV

THE CHRISTIE NHS FOUNDATION TRUST

Trust

1.0668

REN

THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST

Trust

1.0394

RNA

THE DUDLEY GROUP NHS FOUNDATION TRUST

Trust

1.0356

RAS

THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST

Trust

1.1830

RTD

THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

Trust

1.0358

RQW

THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST

Trust

1.1534

RCX

THE QUEEN ELIZABETH HOSPITAL, KING'S LYNN, NHS FOUNDATION TRUST

Trust

1.0259

RL1

THE ROBERT JONES AND AGNES HUNT ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST

Trust

1.0316

RFR

THE ROTHERHAM NHS FOUNDATION TRUST

Trust

1.0272

RDZ

THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST

Trust

1.0647

RPY

THE ROYAL MARSDEN NHS FOUNDATION TRUST

Trust

1.2137

RRJ

THE ROYAL ORTHOPAEDIC HOSPITAL NHS FOUNDATION TRUST

Trust

1.0445

RL4

THE ROYAL WOLVERHAMPTON NHS TRUST

Trust

1.0341

RET

THE WALTON CENTRE NHS FOUNDATION TRUST

Trust

1.0403

RKE

THE WHITTINGTON HOSPITAL NHS TRUST

Trust

1.2134

R1G

TORBAY AND SOUTHERN DEVON HEALTH AND CARE NHS TRUST

Trust

1.0114

RWD

UNITED LINCOLNSHIRE HOSPITALS NHS TRUST

Trust

1.0142

RRV

UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST

Trust

1.2976

RJE

UNIVERSITY HOSPITAL OF NORTH STAFFORDSHIRE NHS TRUST

Trust

1.0242

RM2

UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST

Trust

1.0594

RHM

UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST

Trust

1.0876

RRK

UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST

Trust

1.0449

RA7

UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST

Trust

1.0841

RKB

UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST

Trust

1.0586

RWE

UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST

Trust

1.0434

RTX

UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST

Trust

1.0293

RBK

WALSALL HEALTHCARE NHS TRUST

Trust

1.0344

RWW

WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST

Trust

1.0500

RWG

WEST HERTFORDSHIRE HOSPITALS NHS TRUST

Trust

1.1708

RKL

WEST LONDON MENTAL HEALTH NHS TRUST

Trust

1.1789

RFW

WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST

Trust

1.2014

RYA

WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST

Trust

1.0403

RGR

WEST SUFFOLK NHS FOUNDATION TRUST

Trust

1.0438

RYR

WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST

Trust

1.0809

RA3

WESTON AREA HEALTH NHS TRUST

Trust

1.0530

RY7

WIRRAL COMMUNITY NHS TRUST

Trust

1.0399

RBL

WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST

Trust

1.0389

RWP

WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST

Trust

1.0376

R1A

WORCESTERSHIRE HEALTH AND CARE NHS TRUST

Trust

1.0364

RRF

WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST

Trust

1.0418

RLQ

WYE VALLEY NHS TRUST

Trust

RA4

YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST

Trust

RCB

YORK TEACHING HOSPITAL NHS FOUNDATION TRUST

Trust

RX8

YORKSHIRE AMBULANCE SERVICE NHS TRUST

Trust

1.0245
1.0356
1.0340
1.0408

1.0822

Rivaroxaban for acute coronary syndrome

Assumptions input

The variables listed in the table below can be amended to reflect local circumstances by completing the light blue cells. If local data are not
available the estimate made by NICE can be used.

Variables

Total population of adults aged 18 years and over

Number of admissions with myocardial infarction (STEMI
and NSTEMI) in 2013/14

Source

NICE assumption

Local assumption

The diagram below shows the estimated numbers of patients and

procedures that are affected by the NICE guidance. They are based on
the assumptions made and the population selected.

Variance

Population selection worksheet

78,604

###

*1

0.19%

152

###

% of admissions with STEMI or NSTEMI eligible for

secondary prevention of atherothrombotic events

*1

97.9%

149

###

% of admissions with STEMI or NSTEMI eligible for

secondary prevention of atherothrombotic events who
received treatments

*2

100.0%

149

###

Aspirin plus ticagrelor

*3

0.5%

###

Aspirin plus prasugrel

*3

0.5%

###

Aspirin plus clopidogrel

*3

99.0%

148

###

Aspirin plus clopidogrel plus rivaroxaban

*4

0.0%

###

100.0%

0.00%

-100.0%

149

###

149

###

Current practice

Treatment interventions available

Totals

Future practice
% of admissions with STEMI or NSTEMI eligible for
secondary prevention of atherothrombotic events

*1

97.9%

% of admissions with STEMI or NSTEMI eligible for

secondary prevention of atherothrombotic events to
received treatments

*2

100.0%

Aspirin plus ticagrelor

*3

0.5%

###

Aspirin plus prasugrel

*3

0.5%

###

Aspirin plus clopidogrel

*5

85.0%

127

###

Aspirin plus clopidogrel plus rivaroxaban

*5

14.0%

21

###

100.0%

0.00%

-100.0%

21

###

Treatment interventions available

Totals

Potential savings

Increased number cases treated with aspirin plus

clopidogrel plus rivaroxaban

Incidence of myocardial infarction - aspirin plus clopidogrel

4.9%

###

Incidence of myocardial infarction - aspirin plus clopidogrel

plus rivaroxaban

4.3%

###

###

###

###

###

Reduction in myocardial infarction

Non-coronary artery bypass grafting thrombolysis in

myocardial infarction major bleeding (non-CABG)

0.0%

Incidence of non-CABG thrombolysis in myocardial

infarction major bleeding associated with aspirin plus
clopidogrel

0.4%

Incidence of non-CABG thrombolysis in myocardial

infarction major bleeding associated aspirin plus
clopidogrel plus rivaroxaban

1.3%

Increase in non-CABG thrombolysis in myocardial infarction

major bleeding
Unit costs
Aspirin plus ticagrelor

Unit costs worksheet

721

Aspirin plus prasugrel

Unit costs worksheet

629

Aspirin plus clopidogrel

Unit costs worksheet

36

Aspirin plus clopidogrel plus rivaroxaban

Unit costs worksheet

801

4,217

746

Actual or suspected myocardial infarction

Non-coronary artery bypass grafting thrombolysis in
myocardial infarction major bleeding

Unit costs worksheet

Unit costs worksheet

Rivaroxaban for acute coronary syndrome

Cost for selected population using standard NICE

assumptions

Costing template

Cost for selected population using local assumptions

Err:508
Unit cost () /
proportion
Total population selected (adults 18 years and over)
Number of admissions with myocardial infarction (STEMI and NSTEMI) in
2012/13

Per 100,000 population

Units

Unit cost () /
proportion

Total cost ()
78,604

Units

Total cost ()
78,604

0.19%

152

0.19%

152

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events

97.9%

149

97.90%

149

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events who received treatments

100.0%

149

100.0%

149

0.5%
0.5%
99.0%
0.0%
100.0%

1
1
148
0
150

0.5%
0.5%
99.0%
0.0%
100.0%

1
1
148
0
150

721
629
36
801

1
1
148
150

721
629
36
801

1
1
148
150

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events

97.9%

149

97.9%

149

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events to received treatments

100.0%

149

100.0%

149

0.5%
0.5%
85.0%
14.0%
100.0%

1
1
127
21
150

0.5%
0.5%
85.0%
14.0%

1
1
127
21
150

721
629
36
801

1
1
127
21

721
629
36
801

1
1
127
21

Current practice

Treatment options

Aspirin plus ticagrelor

Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban

Total
Unit costs
Aspirin plus ticagrelor
Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban
Estimated costs of current practice

721
629
5,328
0
6,678

721
629
5,328
0
6,678

Future practice

Treatment options
Aspirin plus ticagrelor
Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban
Total
Unit costs
Aspirin plus ticagrelor
Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban
Estimated costs of future practice
Gross resource impact

150

721
629
4,572
16,821
22,743

16,065

150

721
629
4,572
16,821
22,743

16,065

Potential savings - reduced risk of myocardial infarction

Increased number cases treated with aspirin plus clopidogrel plus rivaroxaban
Incidence of myocardial infarction - aspirin plus clopidogrel

21

21

4.9%

Incidence of myocardial infarction - aspirin plus clopidogrel plus rivaroxaban

4.3%

Reduction in the number of myocardial infarction events

-0.6%

Unit cost
Actual or suspected myocardial infarction

4,217

Estimated savings from reduced risk of myocardial infraction

4.9%

4.3%

-0.6%

4,217

Cost of non-CABG thrombolysis in myocardial infarction major

bleeding
Increased number cases treated with aspirin plus clopidogrel plus rivaroxaban

21

21

Incidence of non-CABG thrombolysis in myocardial infarction major bleeding

associated with aspirin plus clopidogrel

0.4%

0.4%

Incidence of non-CABG thrombolysis in myocardial infarction major bleeding

associated aspirin plus clopidogrel plus rivaroxaban

1.3%

1.3%

Increase in non-CABG thrombolysis in myocardial infarction major bleeding

0.9%

0.9%

746

746

Unit costs
Non-CABG thrombolysis in myocardial infarction major bleeding
Estimated additional cost of non-CABG thrombolysis in myocardial major
bleeding
Net resource impact

0
16,065

0
16,065

Rivaroxaban for acute coronary syndrome

Sensitivity analysis - Population of 100,000

The table below shows the sensitivity of the total cost of implementation to changes in each variable individually. If there are 2 or more variables that make up 100% between them,
they have been varied together to ensure the model remains realistic.

Individual variable sensitivity

Number of admissions with myocardial infarction

Recurrent costs

Baseline value Minimum value Maximum value Baseline costs Minimum costs Maximum costs
0.19%
0.18%
0.20%
16,065
14,535
16,830

Change
2,295

Current treatment
% of admissions with STEMI or NSTEMI eligible for secondary prevention of
atherothrombotic events

97.90%

95.80%

99.900%

16,065

15,300

16,065

765

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events who received treatments
Aspirin plus ticagrelor
Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban

100.0%
0.50%
0.50%
99.00%
0.00%

95.00%
0.50%
0.50%
99.00%
0.00%

100.00%
1.00%
1.00%
98.00%
0.00%

16,065
16,065
16,065
16,065
16,065

15,300
16,065
16,065
16,065
16,065

16,065
16,101
16,101
16,101
16,101

765
36
36
36
36

Future treatment
% of admissions with STEMI or NSTEMI eligible for secondary prevention of
atherothrombotic events

97.9%

95.80%

99.80%

16,065

15,300

16,065

765

% of admissions with STEMI or NSTEMI eligible for secondary prevention of

atherothrombotic events who received treatments
Aspirin plus ticagrelor
Aspirin plus prasugrel
Aspirin plus clopidogrel
Aspirin plus clopidogrel plus rivaroxaban

100.0%
0.5%
0.5%
85.0%
14%

95.00%
0.50%
0.50%
89.00%
10.00%

100.00%
1.00%
1.00%
80.00%
18.00%

16,065
16,065
16,065
16,065
16,065

15,300
11,475
11,475
11,475
11,475

16,065
20,619
20,619
20,619
20,619

765
9,144
9,144
9,144
9,144

Rivaroxaban for acute coronary syndrome

Costs over time - Per 100,000 population

Costs over time are presented for illustrative purposes only. Progression towards implementation
will vary according to baseline position and degree of change required.

Year
Details

2015

2016

2017

2018

2019

Rivaroxaban market share

5%

12%

14%

14%

14%

Eligible population (18 years and older)

149

149

149

149

149

18

21

21

21

Incidence of MI - aspirin plus clopidogrel

4.9%

4.9%

4.9%

4.9%

4.9%

Incidence of MI - aspirin plus clopidogrel plus rivaroxaban

4.3%

4.3%

4.3%

4.3%

4.3%

Incidence of non-CABG thrombosis in MI major bleeding with aspirin plus

clopidogrel

0.4%

0.4%

0.4%

0.4%

0.4%

Incidence of non-CABG thrombosis in MI major bleeding with aspirin plus

clopidogrel plus rivaroxaban

1.3%

1.3%

1.3%

1.3%

1.3%

4,217

4,217

4,217

4,217

4,217

746

746

746

746

746

765

765

765

765

765

5,360

13,780

16,060

16,060

16,060

Number of people on rivaroxaban

Reduction in MI events due to rivaroxaban

Reduction in MI events due to rivaroxaban

Non-coronary artery bypass grafting thrombolysis in MI major
bleeding (non-CABG

Increased events of non-CABG thrombosis in MI major bleeding

Unit costs
Actual or suspected myocardial infarction
Non-coronary artery bypass grafting thrombolysis in myocardial infarction
major bleeding
Incremental cost (Rivaroxaban)
Local discount with rivaroxaban
Cost impact - rivaroxaban
Potential savings - reduced MI events

Cost impact - non- CABG thrombosis in MI major bleeding

5,360

13,780

16,060

16,060

16,060

Net resource impact

Costs over time

18,000
16,000

16,060

16,060

16,060

2017

2018

2019

13,780

14,000
12,000
10,000

Cost

8,000
6,000

5,360

4,000
2,000
0

2015

2016

Year

Rivaroxaban for acute coronary syndrome

Unit cost calculations

Table 1: Unit costs

D
Details
Dosage per day (mg)
Unit cost
2.5 mg, 56 capsule packet
75mg, 28 tablets packet
75mg, 28 tablets packet
90mg, 56 tablets packet
10mg, 28 tablets packet
Cost per day
Annual cost

Aspirin
75

Clopidogrel
75

0.82
1.89

0.03
11.00

0.07
25.00

Aspirin
75

Clopidogrel
75

Table 2: Unit costs - Local input

D
Details
Dosage per day (mg)
Unit cost
2.5 mg, 56 capsule packet
75mg, 28 tablets packet
75mg, 28 tablets packet
90mg, 56 tablets packet
10mg, 28 tablets packet
Cost per day
Annual cost
Discount allowed
Net annual cost

0.82
1.89

0.03
11.00

0.07
25.00

11.00

25.00

Table 3: Weighted average unit cost of myocardial infarction

Description

HRG

Activity

Actual or Suspected Myocardial Infarction, with CC Score 13+

EB10A

4,893

Actual or Suspected Myocardial Infarction, with CC Score 10-12

EB10B

12,631

Actual or Suspected Myocardial Infarction, with CC Score 7-9

EB10C

21,329

Actual or Suspected Myocardial Infarction, with CC Score 4-6

EB10D

30,505

Actual or Suspected Myocardial Infarction, with CC Score 0-3

EB10E

25,463

Rehabilitation for Acute Myocardial Infarction or Other Cardiac Disorders

VC38Z

Total

94,821

Table 5: Weighted average unit cost of major bleeding

Description
Major Therapeutic Endoscopic, Upper or Lower Gastrointestinal Tract Procedures, 19
years and over, with CC Score 3+
Major Therapeutic Endoscopic, Upper or Lower Gastrointestinal Tract Procedures, 19
years and over, with CC Score 1-2
Major Therapeutic Endoscopic, Upper or Lower Gastrointestinal Tract Procedures, 19
years and over, with CC Score 0
Intermediate Therapeutic General Abdominal Procedures, 19 years and over, with CC
Score 3+
Intermediate Therapeutic General Abdominal Procedures, 19 years and over, with CC
Score 1-2
Intermediate Therapeutic General Abdominal Procedures, 19 years and over, with CC
Score 0

HRG

Activity

FZ24G

1,365

FZ24H

4,793

FZ24J

10,069

FZ27E

664

FZ27F

1,448

FZ27G

3,497

Gastrointestinal Bleed with Multiple Interventions, with CC Score 5+

FZ38G

1,023

Gastrointestinal Bleed with Multiple Interventions, with CC Score 0-4

FZ38H

1,331

Gastrointestinal Bleed with Single Intervention, with CC Score 8+

FZ38J

1,031

Gastrointestinal Bleed with Single Intervention, with CC Score 5-7

FZ38K

1,957

Gastrointestinal Bleed with Single Intervention, with CC Score 0-4

FZ38L

7,285

Gastrointestinal Bleed without Interventions, with CC Score 9+

FZ38M

2,273

Gastrointestinal Bleed without Interventions, with CC Score 5-8

FZ38N

11,367

Gastrointestinal Bleed without Interventions, with CC Score 0-4

FZ38P

65,047

Intermediate Upper Gastrointestinal Tract Procedures, 19 years and over

FZ59Z

18,233

Diagnostic Endoscopic Upper Gastrointestinal Tract Procedures, 19 years and over

FZ60Z

177,731

Therapeutic Endoscopic Upper Gastrointestinal Tract Procedures, 19 years and over

Major, Oesophageal, Stomach or Duodenum Procedures, 19 years and over, with CC
Score 7+
Major, Oesophageal, Stomach or Duodenum Procedures, 19 years and over, with CC
Score 4-6
Major, Oesophageal, Stomach or Duodenum Procedures, 19 years and over, with CC
Score 2-3
Major, Oesophageal, Stomach or Duodenum Procedures, 19 years and over, with CC
Score 0-1

FZ70Z

22,942

FZ83G

481

FZ83H

716

FZ83J

1,508

FZ83K

7,921

Total

342,682

Notes
You can input your own local data in the cells highlighted in blue to reflect local practice.
Drug prices were obtained from the NHS electronic drug tariff. Accessed on the 06/01/2015 and available from:
http://www.ppa.org.uk/edt/January_2015/mindex.htm
No administration costs are expected as a result of using rivaroxaban or current treatment options

The weighted average costs of myocardial infarction and major bleeding are based on the NHS reference costs for 20
of myocardial infarction also includes rehabilitation costs. For myocardial infarction rehabilitation is for 5 days. This is b
submitted for the guidance on rivaroxaban for preventing adverse outcomes after acute management of acute coronar

Drugs used
Ticagrelor
180

Prasugrel
10

Rivaroxaban
5
58.88

54.60
1.95
710.00

47.56
1.70
618.00

2.10
765.00

Drugs used
Ticagrelor
180

Prasugrel
10

Rivaroxaban
5
58.88

54.60
1.95
710.00

47.56
1.70
618.00

2.10
765.00

710.00

618.00

765.00

Reference
cost

Weighting

Weighted average
cost

5.2%

4,484

231

13.3%

3,567

475

22.5%

2,881

648

32.2%

2,436

784

26.9%

2,098

563
1,515

100.0%

4,217

e 06/01/2015 and available from:

Reference
cost

Weighting

Weighted average
cost

0.4%

1,943

1.4%

917

13

2.9%

803

24

0.2%

4,073

0.4%

2,749

12

1.0%

2,043

21

0.3%

5,040

15

0.4%

3,167

12

0.3%

3,848

12

0.6%

2,763

16

2.1%

1,996

42

0.7%

2,084

14

3.3%

1,344

45

19.0%

788

150

5.3%

346

18

51.9%

423

219

6.7%

645

43

0.1%

7332

10

0.2%

5240

11

0.4%

3922

17

2.3%

1,606

37

100.0%

746

ased on the NHS reference costs for 2013/04 for both activity and unit costs. The cost
ction rehabilitation is for 5 days. This is based on the expert review group report
fter acute management of acute coronary syndrome.

Rivaroxaban for acute coronary syndrome

References and data sources

1

The data was obtained from the 'Myocardial Ischaemia National Audit Project; How the NHS cares for patients with heart attack. Annual Public Report. April 2013 - March 2014.

We have assumed that all those eligible for secondary prevention treatment will go on to have one of the available treatments options.

The proportions of people with non-ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI) currently having the available treatment options are based on
data obtained from the manufacturer's submission. The submission states that approximately 99% of the people with STEMI and NSTEMI eligible for secondary prevention of atherothrombotic events currently
have aspirin plus clopidogrel and the remaining 1% have aspirin alone. However, based on clinical opinion, current practice is that people have aspirin plus prasugrel or aspirin plus ticagrelor rather than aspirin
alone. Therefore the costing template assumes an equal split of 0.5% each between aspirin plus prasugrel or aspirin plus ticagrelor.

As rivaroxaban has not been recommended before the issuing of this guidance, we have assumed that currently no patients have this treatment option.

The manufacturer's submission states that the market share of rivaroxaban will rise to 14% by 2017 and remain at that level until 2019. It also assumes that rivaroxaban will draw patients from the clopidogrelbased treatments. Therefore we have reduced the current proportion of patients on aspirin plus clopidogrel by 14%.

The data was obtained from the manufacturer submission for the NICE technology appraisal guidance on rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome.

Population data
The populations shown are residential populations of the geographical area of each health body.
Data for 'England - CCGs'; 'Wales - Health Boards'; 'NHS England Area Teams' and 'Local Authorities' were from:
Office for National Statistics (ONS); Resident population - 2011 mid-year estimates
Data for Northern Ireland Health and Social Care Trusts from:
Northern Ireland Statistics and Research Agency (NISRA);Resident population - 2013 mid-year estimates