Point of care testing: Disruptive innovation – is the NHS ready for it yet?

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.

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Exploring the value of a rapid, on-demand test for the detection of human papillomavirus

We explored the use of a rapid, on-demand human papillomavirus (HPV) test as part of a cervical screening programme. Through semi-structured interviews with experts from across the UK, we found that a co-located, laboratory-based, and on-demand HPV test following cytology could reduce the time to results by up to a week, whilst a near-patient test under primary HPV screening followed by cytology triage could radically change the testing paradigm, with most women notified the same day.

presentation_iconAdams 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.

 

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The benefits and cost-savings of a new point-of-care test for chlamydia and gonorrhoea

Problem: Cepheid’s Xpert® CT/NG test is a high performance point-of-care test for chlamydia and gonorrhoea, and offers a promising advance in the diagnosis and control of two common sexually transmitted infections. When the test was launched in 2013, Cepheid wanted to understand how sexual health clinics in England might use it and to develop evidence comparing its costs and benefits to standard laboratory tests.

Approach: We approached the challenge in two projects. For the first, we defined the current patient pathways for chlamydia and gonorrhoea testing treatment and compared them to what they would be if a rapid POCT was used. We held workshops with staff in four sexual health clinics, asking them to map out the current patient pathways for chlamydia and gonorrhoea diagnosis and treatment. We then helped them brainstorm ways in which their services might include a point-of-care chlamydia and gonorrhoea test, and describe how this would change their patient pathways. Finally, we used Dots, our cloud-based pathway builder tool, build to estimate the costs of the pathways. The work indicated that the pathways could be streamlined with a point-of-care test, and we estimated that this would cost less to deliver than current practice.

For the second project, we developed an economic model to compare the overall costs and benefits of a point-of-care test to standard care. We combined the results of our first project with previous work our team had conducted on chlamydia and gonorrhoea testing and management. The model showed that the test could deliver £10million in cost savings, and give far more effective management of chlamydia and gonorrhoea at a population level. Our results were published in Sexually Transmitted Infections, and have been presented at national and international conferences.

Impact: Our work gave Cepheid the empirical evidence to demonstrate the value and potential impact of adopting their test in clinics. Since our projects, Cepheid has had increasing interest in the test, and several centres have purchased it. This includes a major London sexual health clinic which has introduced a new testing service as a result.

 

Testimonial

“I started working with Aquarius in 2012. Elisabeth and her team have always delivered great results, including 2 peer-reviewed publications, that add real value and insight, and they come up with creative ways to answer our questions. I enjoy collaborating with them and look forward to continuing our work on a range of disease areas in the future.”

  • Dr. Anne Postulka, Senior Director Medical & Economic Value, Cepheid

 

Related publications

publication_iconAdams EJ, Ehrlich A, Turner KME, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014;4: e005322. doi:10.1136/bmjopen-2014-005322

publication_iconTurner KME, Round J, Horner PJ, et. al. What are the clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England? Sex Transm Infect. Published online 22 Nov 2013: doi:10.1136/sextrans-2013-051147

Featured article: Read the Clinical Services Journal about this work.

 

Point-of-care testing leads the way: article in the Parliamentary Review 2014

Rapid point of care test for sexually transmitted infection diagnosis will allow greater access to high quality care, ensure patients get the correct treatment for their infections, and return to health sooner, reducing the need for follow-up care and preventing onward transmission and complications.

publication_iconPrice C, Adams E, Horner P. Point-of-care testing leads the way. Parliamentary review: Sept 2014

 

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Mapping patient pathways and cost of point of care versus standard testing and treatment for chlamydia and gonorrhoea in sexual health clinics

This study aimed to explore the current patient pathways for the diagnosis and treatment of chlamydia and gonorrhoea in England. We conducted workshops in four sexual health clinics, and asked them detail the steps and resources used in screening, diagnosis and treatment, and what would change if they had a point of care test (POCT) for chlamydia and gonorrhoea diagnosis. Using a POCT could lead to reduced clinical time and costs, and may lead to more appropriate and quicker care for patients.

Read Journal ArticleAdams EJ, Ehrlich A, Turner KME, et al. Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK. BMJ Open 2014;4:e005322. doi:10.1136/bmjopen-2014-005322

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