Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits

With collaborators at Chelsea and Westminster NHS Foundation Trust, we estimated the impact of a rapid testing and result notification service for patients testing for sexually transmitted infections at the Dean Street Express clinic. We found that a rapid testing service for asymptomatic infections resulted in 8 days’ faster time to result notification for CT and/or NG which enables faster treatment, thus reducing infectious periods and leading to fewer transmissions, unnecessary partner attendances and clinic costs, compared with those attending an existing ‘standard’ sexual health clinic.

PublicationGary G Whitlock, Daniel C Gibbons, Nick Longford, Michael J Harvey, Alan McOwan, Elisabeth J Adams Rapid testing and treatment for sexually transmitted infections improve patient care and yield public health benefits
International Journal of STD & AIDS. First Published October 23, 2017
https://doi.org/10.1177/0956462417736431

 

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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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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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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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Providing integrated HIV treatment and care for stable patients in general practice

We implemented a nurse-delivered integrated HIV and primary care service pilot study for stable patients in two local inner city general practices. Initial results from the patients in the study indicate that a novel model of HIV care with a greater emphasis on patient convenience appears to have high levels of patient satisfaction and favourable treatment outcomes; further work will analyse the costs and impact of the service.

presentation_iconAlexander H, Richards P, Brady M, et al. Providing integrated HIV treatment and care for stable patients in general practice. 21st Annual Conference of the British HIV Association. 21 – 24 April 2015, Brighton, UK

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The cost and tariff reimbursement of idiopathic pulmonary fibrosis in England

We explored patient pathways for the diagnosis, management and monitoring of idiopathic pulmonary fibrosis (IPF). This was based on NICE published pathways, and interviews with healthcare staff from 14 hospital trusts across England. Data were used in our in-house tool to estimate the cost of each pathway, which were compared to the tariff reimbursement. We found large variation across England in how services for IPF patients are delivered, and variation compared to the NICE pathway.

View PosterHill C, Nasr R, Fisher MI, et. al. Estimated cost and payment by results (PBR) tariff reimbursement for idiopathic pulmonary fibrosis services across 14 specialist providers in England. British Thoracic Society Winter Meeting, London UK. 5th December 2014 MRC-2731

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Treatment for stable HIV patients in England: can we save costs and improve patient care?

We estimated the costs of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients in England. Results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the least expensive option and could result in £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in England.

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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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

 

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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.

 

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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.

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