Modelling the costs and benefits of an mRNA compared to a DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada

Cases of cervical cancer in Canada have decreased recently as a result of cytology-based screening programs. However, cervical cancer remains a relatively common and preventable cause of cancer in women. As cervical cancer is primarily caused by persistent genital infection with high-risk (HR) human papillomaviruses, Ontario Health has been evaluating implementing HPV-based testing in cervical screening.

As the type of HR-HPV test used in a cervical screen program can impact costs and resources, Aquarius Population Health developed a decision tree model to compare the use of the Aptima mRNA HR-HPV assay to a DNA HR-HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada.

Results found for women aged 30-65 years screened in Ontario, using an mRNA versus a DNA HR-HPV assay would save over $4M CAD and avoid roughly 11,000 unnecessary colposcopies, 15,000 HPV tests and 40,000 cytology tests.

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An exciting start to 2021

The challenges and opportunities of growing a team during these strange times

2020 was a year like no other, including for the team at Aquarius. We learned how to work from home and adapt to seeing our colleagues and clients on our screen. Members of the team have had to juggle the roles of worker and parent/carer or living alone during the lockdown while continuing to deliver excellent, meaningful and impactful work that supports decision-making at national, international, and local/regional levels.

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Aquarius gives back in 2020

Working with us gives health, wellbeing and safety to those who need it most

Aquarius Population Health is passionate about improving health and wellbeing at home and abroad. We are extremely fortunate that our work makes a real difference to the health of the wider population, and that our team is able to grow and achieve fulfilment in their work.  Additionally, we are grateful to be able to give back directly to others in need. 

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Is it cost effective to screen women for syphilis twice during pregnancy?

The UK National Screening Committee (UK NSC) asked Aquarius to assess the costs and benefits of two different approaches to antenatal screening for syphilis.

We compared the current strategy – screening in the first trimester only – with an alternative strategy – screening in the first trimester and a repeat screen later in pregnancy.  The results of our cost-effectiveness analysis were recently published in BMJ Open and are now available online.

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Could we optimise testing for gonorrhoea to avoid the use of last-line antibiotics?

Ceftriaxone is the first-line treatment for gonorrhoea but there are few alternative treatments available should ceftriaxone resistance become widespread. Aquarius created a model to explore how point-of-care testing could be used to diagnose gonorrhoea and at the same time test for antibiotic susceptibility, which could allow the use of previously abandoned antibiotics for many patients, thereby sparing ceftriaxone use.

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How can economic models inform decision-making about screening programmes?

Dr Elisabeth Adams, Managing Director and Founder of Aquarius Population Health, spoke at a continuing medical education webinar for health professionals hosted on September 23,2020 by the Consortium for Infectious Disease Control (CIDC).  

With increasing demands on time and resources, decision-makers in healthcare need information about how to create a safe, effective and cost-effective screening programme. Elisabeth discussed how theoretical quantitative evidence from health economic evaluations and models can inform decision-making, and guide policy decisions at local, regional, national and international levels in the absence of empirical data.

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Aquarius part of collaborative NIHR grant to evaluate Odin Vision’s artificial intelligence technology to fight bowel cancer

In the UK, 42,000 new diagnoses and 16,000 deaths occur from bowel cancer each year. Bowel cancer is the second most common cause of cancer death in the UK, comprising over 10% of all deaths due to cancer. (1)

A recent study found that almost one third of bowel cancer patients experience an avoidable delay in their diagnosis. (2) Earlier detection of bowel cancer can result in better patient outcomes.  With the goal of achieving earlier diagnosis of cancer and saving more lives, the NIHR AI in Health and Care Award was announced by the Health Secretary, the Rt Hon Matt Hancock MP, at London Tech Week. The National Institue for Health research (NIHR) has awarded £140M in funding to back development of the most promising technologies in artificial intelligence (AI).  Odin Vision Ltd was awarded a grant to support the development of their new AI technology, the CADDIE system, which uses machine learning to assist doctors in identifying and removing abnormalities during a colonoscopy. (3)

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How much would community-based screening for chlamydia and gonorrhoea cost?

We collaborated with St George’s, University of London, on a NIHR-funded ‘Test n Treat’ (TnT) study. This study assessed the cost of providing same-day chlamydia and gonorrhoea testing and treatment service at higher education colleges. The paper presenting this work was published in BMC Health Services Research and is now available online.

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Using an mRNA versus DNA test in the English cervical screening programme can save £15m annually and reduce unnecessary testing

The results of our economic evaluation comparing the use of mRNA and DNA assays in screening for cervical cancer in England were published in BMJ Open and are now available online. Results show large cost savings from avoiding unnecessary testing and follow-up, which can benefit women and healthcare services.

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