We created a mathematical model to investigate the treatment impact and economic implications of introducing an antimicrobial resistance point-of-care test (AMR POCT) for gonorrhoea as a way of extending the life of current last-line treatments. The introduction of AMR POCT could allow clinicians to discern between the majority of gonorrhoea-positive patients with strains that could be treated with older, previously abandoned first-line treatments, and those requiring our current last-line dual therapy. Such tests could extend the useful life of dual ceftriaxone and azithromycin therapy, thus pushing back the time when gonorrhoea may become untreatable.
Our paper explores results of the acceptability and implementation issues of point of care tests (POCTs) in paediatric patients in three south London hospitals. Overall, we found that having a test result was thought to improve bed management and cohorting sick patients appropriately, reassure parents about their child’s condition, reduce hospital transmission, and rationalise further tests and treatment. Concerns focused on confidence about the test’s performance – particularly around false negatives not receiving proper management, how to manage discrepant results (i.e. the laboratory assay gave a different answer to the POCT), and training enough staff to run the test at the point of care.
Bustinduy AL, Jeyaratnam D, Adams EJ, et al. CLAHRC South London; Paediatric Infection Network. Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals. Acta Paediatrica, April 2017. DOI: 10.1111/apa.13867
Our Managing Director, Elisabeth Adams, spoke in November about the importance of exploring the health economics of point of care testing (POCT) at the Royal Society of Medicine Telemedicine and eHealth event in London. The video of her presentation is now online – view the full talk here.
Why is it important to explore the health economics of point of care testing (POCT)?
Evaluating the health economics of POCTs can help us better understand the cost, benefits and value of implementing these tests, compared to standard laboratory tests. We need to explore the acquisition costs of innovative technology like POCTs compared to standard tests, as well as the benefits generated for patients, service providers, clinicians and public health in general. Benefits can include faster results, better care, fewer complications, more efficient services and better use of resources, and knock-on benefits like reduced prevalence of disease. Those making purchasing decisions for new tests need evidence to prove the value of the tests.
Prevention of cervical cancer in women is the focus of vaccination and screening programmes globally. However, there is no consensus on the best way to approach screening, and screening across Europe varies considerably. Innovations in diagnostic testing and new ways to engage women in screening may improve screening uptake and increase the efficiency of screening pathways. In this talk, we explore opportunities for a rapid or point of care test for HPV as part of the screening pathway, and how self-sampling may be an effective way to engage women in screening.
We explored the impact of introducing a high performance point of care test (POCT) for influenza and respiratory syncytial virus (RSV) on an acute paediatric ward of a large London hospital during influenza season compared to standard care of using a laboratory-based test. We estimated the outcomes before and after implementing a POCT (Enigma® MiniLab™ FluAB-RSV test) for paediatric patients admitted to an acute respiratory ward in the 2013/14 and 2014/15 respiratory seasons. There was a significant reduction in reimbursement charges for influenza- and RSV-negative patients, for the full hospital stay and the period on the acute paediatric ward after implementing the POCT, however, these differences disappeared when controlling for top-up service charges. More appropriate treatment of patients with influenza occurred after implementing the POCT (40% versus 13% received oseltamivir, p=0.02). There was no difference in length of stay between the two periods. Findings indicate cost savings for commissioners and hospitals, even without a reduction in the length of stay.
Vecino-Ortiz AI, Glover RE, Douthwaite ST, et al. Estimating the clinical impact and costs of implementing a point of care test for influenza A/B and respiratory syncytial virus on an acute paediatric hospital inpatient ward. Society for Medical Decision Making. 12-14 June 2016. London, UK.
We created a decision tree to estimate the unnecessary isolation days averted by early diagnosis of false positive patients with a point of care test for influenza compared to presumptive isolation and standard laboratory testing (12 versus 2 hours’ time to results). Assuming a 7% prevalence of influenza in a cohort of 300 patients with suspected influenza, average hospital stay of 3 days, and the cost of an isolation bed being 10% more than a ward bed, using a point of care test could avert 80-95% of the unnecessary isolation days, with an associated estimated cost savings of roughly £7000-£9000, depending on if they test were implemented on the ward or in A&E, respectively. Point of care tests could improve bed management and reduce unnecessary isolation days and the associated costs, and reduce hospital transmission of infection.
Vecino-Ortiz AI, Glover RE, Rabe AJ, et al. A rapid influenza test in hospitals could avoid unnecessary paediatric isolation bed days and save cost. Society for Medical Decision Making. 12-14 June 2016. London, UK.
We assessed the performance of the new point-of-care Enigma® MiniLab™ assay for Influenza A, B and RSV compared to a centralised laboratory respiratory virus panel. The positive per cent agreement was >95% for Influenza B and RSV but was 79.2% (95% CI 57.8-92.9%) for Influenza A, and the negative per cent agreement was >95% for Influenza A and B, and 94.5% (95% CI 91.9-96.4%) for RSV. The turnaround time for the laboratory respiratory virus panel was 24 hours, compared to ~90 minutes for the Enigma® MiniLab™ test.
Douthwaite ST, Walker C, Adams EJ, et al. Performance of a novel point-of-care molecular assay for the detection of Influenza A, B and Respiratory Syncytial Virus (Enigma® MiniLab™) in children with acute respiratory infection. JCM, online first 11 Nov 2015. doi: 10.1128/JCM.02887-15
Breast cancer is the most common cancer in women in England and the second most common cause of cancer death. We mapped the breast cancer diagnostic pathway in England and rest of Europe and estimated the number of women transitioning through each step of the pathway, and the number of symptomatic women. We propose a new metric to discuss breast cancer screening, annual effective screening rate, to allow for comparison of the effectiveness of different breast cancer interventions across Europe.
Problem: Our client Cepheid has developed a rapid HPV PCR test that can be used as a point-of-care test (POCT). They wanted to understand where in the cervical cancer screening and treatment pathway the test would be most beneficial to patients and the healthcare system. This comes during a time of uncertainty about how best to screen women, and how to organise laboratory services around screening. It is also unclear how screening may differ across Europe and the burden of cervical disease.
Approach: We conducted a literature review of the evidence about the current national cervical screening programme in the UK. Then, we conducted 25 semi-structured interviews with key opinion leaders across the UK to gain additional insight about the pathway and the opportunities for using a POCT in the screening pathway. Results also contributed to a European tool to understand cervical cancer diagnosis and burden.
Impact: We have presented our findings at international conferences (EUROGIN 2015, IPC 2015), and results have helped our client as they communicate the opportunities and value of a POCT for HPV to their stakeholders and customers. We have engaged with the international community on the requirements for the creation of a standardised international cervical cancer data repository, to inform better evidence-based decision making.
“While perfectly responding to the originally given mission, the Aquarius team painted a comprehensive picture of how healthcare is really delivered currently in Europe. This opened up our minds to new ways of improving patient care. The Aquarius team under Elisabeth’s leadership is highly professional, very creative and great fun to work with, without ever taking short cuts. I cannot imagine better results for us.”
- Dr Anne Postulka, Senior Director Medical & Economic Value, Cepheid
Adams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.
Adams EJ, Glover R, Vecino A, Postulka A. How can European countries improve cervical cancer prevention for women? 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.
We developed a framework to help clinicians and decision-makers think systematically about how to compare patient management options whilst considering the full costs to the healthcare provider, and a toolkit based on this framework for patients with invasive fungal infection in England. Adopting this framework can help healthcare providers move towards a more holistic understanding of drug treatment and management costs that may help the NHS save money, freeing up resources for better health care.