Three simple tests could save the NHS nearly £6.9 billion

This year marks the 70th birthday of the NHS – a time to celebrate its achievements and the dedicated staff who keep its wheels turning. Yet, there is increasing concern about the future of the NHS, and particularly its funding. In this article, jointly commissioned by the British In Vitro Diagnostics Association (BIVDA) and Innovate UK, we showcase three tried and tested in vitro diagnostics, which, if more widely adopted, could save the NHS an estimated £6.9 billion over the next five years.

 

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Test n Treat – rapid STI testing and treatment in colleges: study protocol

Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We describe the study protocol for “Test and Treat” (TnT), an NIHR-funded research study. This is a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing using the Cepheid GeneXpert system and same-day treatment in six FE colleges. As part of the study we also conducted qualitative and economic assessments to assess the feasibility of conducting a future large-scale trial to investigate if TnT reduces chlamydia rates. The methods for recruitment, participant data collection, sample collection and testing are described, for baseline and follow-up in the control and intervention groups. The statistical analysis plan for TnT has been published separately.

 

PublicationKerry-Barnard S, Fleming C, Reid F, et al. ‘Test n Treat (TnT)’- Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial. Trials. 2018 Jun 5;19(1):311. doi: 10.1186/s13063-018-2674-8.

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

Assessing the impact of point-of-care testing for influenza and respiratory syncytial virus in children admitted to hospital

We assessed the impact and economic benefits of using a point-of-care (POC) assay instead of standard laboratory testing to detect influenza and respiratory syncytial virus (RSV) in children and infants admitted to hospital . This real-world evaluation was conducted in two subsequent ‘flu seasons at the Evelina Children’s Hospital in London. Results showed that following the introduction of the POC testing, children with influenza were more likely to receive oseltamivir treatment, the antiviral recommended for influenza. Although there was no statistically significant reduction in the average length of hospital admission or in the number of antibiotics prescribed, there was a reduction in laboratory costs and in reimbursement charges for hospital admissions suggesting that use of the POC assay resulted in fewer procedures and interventions performed during admissions.

Publication Vecino-Ortiz AI, Goldenberg SD, Douthwaite ST, et alImpact of a multiplex PCR point-of-care test for influenza A/B and respiratory syncytial virus on an acute pediatric hospital ward. Diagnostic Microbiology and Infectious Disease, March 2018. In Press. http://www.dmidjournal.com/article/S0732-8893(18)30103-2/abstract

 

To request a copy of the published article, please email caroline.dombrowski@aquariusph.com.

 

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Exploring HCV eradication through diagnosis and treatment strategies

The World Health Organization aims to eradicate hepatitis C virus (HCV) by 2030. To achieve this, improved HCV diagnosis and treatment coverage are required. We explored the relationship between diagnosis and treatment in the next 5 years in Italy, France, and the UK to understand how to achieve the most benefit.

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Harvey MJ, Cheng C-Y, Leone E, et al. Exploring HCV eradication through diagnosis and treatment strategies. EASL Monothematic Conference, Striving Towards the Elimination of HCV Infection. 2-3 February 2018, Berlin, Germany.

 

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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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Modelling how point-of-care tests can enable personalised treatment for resistant gonorrhoea infections

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.

Publication

Turner KM, Christensen H, Adams EJ, et al Analysis of the potential for point-of-care test to enable individualised treatment of infections caused by antimicrobial-resistant and susceptible strains of Neisseria gonorrhoeae: a modelling study

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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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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

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.

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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.

 

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A rapid influenza test in hospitals could avoid unnecessary paediatric isolation bed days and save costs

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.

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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.

 

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Performance of a novel point-of-care molecular assay for the detection of Influenza A, B and RSV in children

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.

Publication
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

 

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