Mapping the treatment pathway for metastatic uveal melanoma patients in England: A qualitative pilot study

Metastatic uveal melanoma (mUM) is a rare disease, and with few effective therapeutic options it is unclear what patients receive as standard of care. Based on national guidelines, we mapped out real-world patient pathways with clinical experts across regional and supra-regional centres across England, to inform a consensus pathway of care following mUM diagnosis.

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Adams E, Cheng CY, Sacco J, et. al.  Mapping the treatment pathway for metastatic uveal melanoma (mUM) patients in England: A qualitative pilot study. Society for Immunotherapy of Cancer’s 32nd Annual Meeting. 8-10 November 2017, National Harbour, Maryland, USA.

 

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Using real world evidence to characterise a cohort of metastatic uveal melanoma patients in England

We identified a cohort of uveal melanoma (UM) and metastatic uveal melanoma (mUM) patients within England using the Hospital Episodes Statistics database, which had similar characteristics to other cohorts identified in the clinical literature.

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Schwenkglenks M, Alamgir G, Cheng CY, et al. A real world evidence (RWE) approach to characterising an ultra-rare disease (URD) cohort of metastatic uveal melanoma (mUM) patients within National Health Service England (NHSE). International Society for Pharmacoeconomics and Outcomes Annual European Congress. 4-8 November 2017. Glasgow, Scotland, UK.

 

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Quantifying standard of care hospital-related resource utilisation for metastatic uveal melanoma patients in England

We assessed the hospital resource use of a cohort of patient with uveal melanoma and metastatic uveal melanoma identified in the Hospital Episode Statistics in England. This showed differences in where patients receive care before and after they develop metastatic disease, indicated a high burden on health care services, and significant travel distances for patients receiving care.

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Cheng CY, Alamgir G, Adams EJ, et al. Quantifying standard of care (SoC) hospital-related resource utilisation for metastatic  uveal melanoma (mUM) patients in NHS England (NHSE) using the Hospital Episodes Statistics (HES) dataset. International Society for Pharmacoeconomics and Outcomes Annual European Congress. 4-8 November 2017. Glasgow, Scotland, UK.

 

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Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising gonorrhoea treatment

In July, Emma Harding-Esch spoke at the STI and HIV World Congress in Rio on how to best manage the increasing challenge of anti-microbial resistance (AMR). The research she presented was a collaboration between Aquarius Population Health and ADREU St. Georges.  In recent years, there has been an increase in resistance to first-line therapies used to treat STIs such as gonorrhoea. The Aquarius team built a decision tree model to assess the cost-effectiveness of standard care compared to several hypothetical rapid point-of-care tests (POCT) for antibiotic susceptibility. The model simulated a cohort of sexual health clinic attendees. The results showed that while standard care is the cheapest option, AMR POCTs may be cost-effective and maximise the number of effective agents in treatment regimens, providing long-term benefits in some scenarios.

Harding-Esch EM, Huntington SE, Harvey MJ, et al. Cost-effectiveness of antimicrobial resistance point-of-care testing for optimising the treatment of gonorrhoea STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections

We estimated costs, benefits and cost-effectiveness of three accurate 30-minute NAAT POCT strategies that detect different STI combinations, compared with standard care  (laboratory-based NAAT for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG)).  We found the CT-NG-MG-TV POCT strategy was the cheapest using tariff costing. It offered the most benefits, which in turn may have wider public health impacts through rapid and accurate STI diagnosis and management. Different testing strategies may be more cost-effective in different SHCs and patient groups. Further evidence is needed to capture the diversity of STI prevalence and management of patients across clinical services to better inform economic analyses.

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Harding-Esch EM, Huntington SE, Burns RM, et al. Evaluating the costs, benefits and cost-effectiveness of multi-pathogen point-of-care tests for sexually transmitted infections STI & HIV World Congress. 9-12 July 2017. Rio de Janiero, Brazil.

 

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Point-of-care tests for infectious diseases: Barriers to implementation across three London teaching hospitals

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.

Publication

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

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Increased efficiency and improved treatment for stable HIV patients in England

Problem: There was no guidance in England on how frequently stable HIV patients should attend clinics for routine visits, how frequently they should receive their HIV drugs and whether or not it would be cost efficient for patients to collect their drugs from the hospital pharmacy (which incurs VAT) or receive them through a home delivery (with associated delivery cost).

Approach: We built a simple spreadsheet tool in Microsoft Excel to estimate which strategy was the most cost-efficient. Local data from St George’s hospital were obtained and analysed, and supplemented with nationally published data as inputs in the model. Results suggested that the most cost efficient way of delivering care was to see stable patients for routine visits every six months in clinic, and give them their drugs through home delivery every three months; this would also save the most drug wastage for example if patients needed to switch to a new drug regimen. Results suggested that this could save roughly £2000 per patient annually, and roughly £8 million if it were implemented across England to the 4000 HIV patients in 2012.

Impact: Results were given to the London HIV commissioners, published in a peer-reviewed journal, and the tool is available to healthcare professionals so that they can put in their local data to help them make better decisions about healthcare provision.

 

Testimonial

“It has been a pleasure to work with Dr Elisabeth Adams on our costing project for HIV home delivery of drugs. I have also worked with her on research related to the POPI study of chlamydia screening.

She has a very professional and thorough approach to her work, and is good at delivering to timelines. I can recommend her as a partner for future work.”

  • Dr Phillip Hay, Reader and Honorary Consultant, Sexual Health and HIV Medicine, St. George’s Hospital, London

 

Related publications

publication_iconAdams EJ, Ogden D, Ehrlich A, Hay P. Treatment for stable HIV patients in England: can we save costs and improve patient care? Journal of Health Services Research & Policy. Published online 29 Oct 2013, doi:10.1177/1355819613508176

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