How to prevent cervical cancer: HPV – we are coming to get you!

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.

presentation_icon
Adams EJ. How to prevent cervical cancer: HPV – we are coming to get you! EUROGIN. June 15-18, 2016. Salzburg, Austria.

 

Read Publication

Cervical screening and HPV testing: Opportunities for rapid tests

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.

 

Testimonial

“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

 

Related publications

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.

 

presentation_iconAdams 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.

The cost of pelvic inflammatory disease and potential cost-savings of chlamydia screening

Problem: The POPI trial was a randomised control trial in South London estimating the incidence of pelvic inflammatory disease (PID) and the potential impact of screening for chlamydial infection on preventing PID. The study group wanted to know the costs to the health care system of managing PID, and what cost savings could be made through chlamydia screening.

Approach: We worked with the study team to define the question based on the data they had already collected during the trial, and then developed a strategy to answer it. This involved extracting data from patient notes and building a simple model in Excel to estimate the costs of care for women with PID. National costs were applied to local data, and we scaled up the results to estimate the potential cost savings, both locally and nationally.

 Impact: This work provided estimates of the cost of managing PID, which are useful to groups exploring the impact of delivering care to these patients and also for those wishing to explore the impact of interventions to avoid PID such as chlamydia screening. The results were published in Sexually Transmitted Infections, and has been cited many times in prestigious journals and authoritative reports and used in two modelling studies.

 

Testimonial

“Dr Adams is an excellent health economist, very clear thinking and easy to work with. She has original ideas and delivers on time. She designed the cost analysis for our trial, supervised the research assistant who assembled the relevant data and enabled publication in a high ranking journal.”

  • Dr Pippa Oakeshott, Professor of General Medicine, St Georges University

 

Related publications

publication_iconAghaizu A, Adams EJ, Turner KME, et al. What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the POPI (prevention of pelvic infection) trial. Sex Transm Infect 2011; 87:312-317.

How can European countries improve cervical cancer prevention for women?

We conducted a literature review on cervical cancer incidence, screening algorithms and coverage across Europe. Data on the structure and provision of screening programmes are sparse, with large heterogeneity reported by sources. A lack of comparable data across countries makes it challenging for researchers and policy-makers to assess screening effectiveness and what is most beneficial for women. A central data repository could facilitate effectiveness and cost-effectiveness analyses to support the adoption of the best screening algorithm.

presentation_iconAdams 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.

 

Read Publication

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.

 

Read Publication

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.

 

Cost effectiveness of screening for Chlamydia trachomatis in Ireland

In our analysis we estimated the cost and cost-effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland, based on data from a pilot study. We found that a national screening programme would be expensive to implement nationally and would not be deemed cost-effective by policy makers in Ireland.

Journal ArticleGillespie P, O’Neill C, Adams E, et al. Cost effectiveness of opportunistic screening for Chlamydia trachomatis in Ireland. Sex Transm Infect 2012; 88:3, 222-228. doi:10.1136/sextrans-2011-050067

 

Read Publication

Costs and cost-effectiveness of different strategies for chlamydia screening and partner notification

Comparing cost effectiveness and sex equity of different intervention strategies within the English National Chlamydia Screening Programme found that increasing the effectiveness of partner notification was more cost effective and increased the diagnoses in women compared to increasing screening in men. The tool developed in this study can be used with local data to calculate cost effectiveness for chlamydia control programmes.

publication_iconTurner KME, Adams EJ, Grant A, et al. Costs and cost effectiveness of different strategies for chlamydia screening and partner notification: an economic and mathematical modelling study. BMJ, 4;342:c7250, 2011. 10.1136/bmj.c7250.

 

Read Publication

What is the cost of pelvic inflammatory disease and how much could be prevented by screening for chlamydia?

Data from a study of the incidence of pelvic inflammatory disease (PID) and healthcare behaviour were used to estimate the cost of managing PID and the potential impact of chlamydia screening. We found that the average cost of managing PID was £163 in community and hospital settings, and that over £60,000 could be saved in London alone from screening for chlamydia.

publication_iconAghaizu A, Adams EJ, Turner KME, et al. What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the POPI (prevention of pelvic infection) trial. Sex Transm Infect 2011; 87:312-317.

Read Publication