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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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 the burden of non-muscle-invasive bladder cancer in Europe

Bladder cancer is relatively common in the EU. Most cases are non-muscle-invasive bladder cancer (NMIBC), classified into risk groups based on their chance of progression, which determines the frequency and duration of monitoring after treatment. We created a flexible tool to estimate the burden of NMIBC cases in eleven European countries and estimated the number of monitoring cystoscopies by risk group based on national and regional guidelines.

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Vecino-Ortiz AI, Glover RE, Adams EJ. Modelling the burden of non-muscle-invasive bladder cancer in Europe. European Association of Urology. 11-15 March 2016. Munich, Germany.

 

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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.

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

 

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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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Mapping the diagnostic pathway for breast cancer in England and comparison to Europe

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.

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Adams EJ, Midha D, Glover R,  et al.
Mapping the diagnostic pathway for breast cancer in England and comparison to Europe ISPOR 18th Annual European Congress. 7-11 November 2015. Milan, Italy.

 

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Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease

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.

presentation_iconAdams EJ, Kendall E, Horner J, et al. Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease. ECCMID 2015. 25 – 28 April 2015. Copenhagen, Denmark.

 

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