Millions in savings could be unlocked through better implementation of evidence-based treatments

Millions of pounds’ worth of savings and health benefits are left unrealised in the NHS, a new study has shown. Published in Frontiers in Health Services, the paper demonstrates how health systems could unlock huge benefits by implementing evidence-based treatments more effectively.

The study was led by a team of NIHR ARC West and University of Bristol researchers. They focused on how a simple, cost-effective and evidence-based treatment to prevent cerebral palsy in preterm babies could unlock potential health benefits across the NHS in England, Scotland and Wales.

Cerebral palsy is a lifelong disability that affects movement and posture and has profound impacts on individuals and families. It also carries substantial costs for health and social care over a lifetime.

The treatment, magnesium sulphate (MgSO₄), protects an unborn baby’s brain during preterm labour. It has been recommended by health bodies, including the World Health Organization and the UK’s National Institute for Health and Care Excellence, for over a decade.

Despite evidence of clinical and cost-effectiveness, the new research shows that magnesium sulphate uptake remains below optimal levels. This means many eligible women and their babies still miss out on the therapy, and society misses out on the health and economic benefits that come with preventing cerebral palsy.

Using routine health data from 2014 to 2022, the researchers found that use of magnesium sulphate for births before 32 weeks’ gestation rose significantly across the UK. This was thanks in part to quality improvement programmes like the National PReCePT Programme in England, which has helped increase uptake to 80%.

However, optimal implementation – defined in the study as 95% uptake – has still not been achieved in any nation. This leaves a persistent research-to-practice gap.

Value is left unrealised

To express the costs of this gap, the research used a health economics measure called Incremental Net Monetary Benefit (INMB). This puts health gains and economic value into financial terms.

The researchers estimate that in 2022 alone:

• England missed out on about £18.2 million worth of potential value
• Scotland missed £3.7 million
• Wales missed around £1 million

These shortfalls represent the health benefits and lifetime societal savings that would have been realised if more eligible women had received the treatment.

Small investments could lead to big returns

Quality improvement aims to improve services and processes in the NHS. The authors modelled hypothetical quality improvement efforts designed to increase magnesium sulphate use.

They found that even modest increases of a 5% rise in uptake over a year could generate an additional £7.5 million in societal value. This far exceeds the cost of implementing such programmes.

Efforts such as PReCePT have helped improve magnesium sulphate uptake substantially. However, this new research shows there is still room to improve and that doing so is good value for money.

Professor Karen Luyt, PReCePT national clinical lead, said:

“Further improvement in implementing magnesium sulphate remains a possibility. The latest NHS funded UK National Neonatal Audit (2024) reported that 87% of eligible preterm babies benefitted from magnesium sulphate neuroprotection in 2024.

“However, the report also recognised that there is variation between neonatal units. Units with below average delivery of antenatal magnesium sulphate are an opportunity to further increase the benefits of this low-cost treatment.

“This new research demonstrates that future investment in supporting the lowest performing units makes economic sense. The blueprint for implementation already exists.”

Dr Carlos Sillero Rejon, Health Economics Research Fellow at ARC West and the University of Bristol and lead author of the study, said:

“Our study shows the value that could be gained in closing the gap between what clinical evidence shows is effective and what actually happens in practice. Savings wouldn’t just be made in health systems, but across society as a whole.

“Investing in efforts to support implementation is likely to pay off in better health outcomes and economic savings.”