Cervical screening and HPV testing: Opportunities for rapid tests
We explored the use of a rapid, on-demand human papillomavirus (HPV) test. Interviews with UK experts revealed that a co-located, on-demand HPV test following cytology could reduce the time to cervical screening results by up to a week, with a near-patient primary HPV test followed by cytology triage could radically change the testing paradigm. A follow-up tool we built in Excel was used to understand cervical screening burden and HPV testing across Europe.
The cost of pelvic inflammatory disease and potential cost-savings of chlamydia screening
We worked with clinicians from St Georges University who had published a trial estimating the incidence of pelvic inflammatory disease (PID) among women screened and unscreened for chlamydia. Patient data was analysed, and the average cost of managing PID was estimated to be £163 in community and hospital settings, and that over £60,000 could be saved in London alone from screening for chlamydia. This paper has been cited widely and results have informed policy and further modelling studies.
Thinking critically about the value and cost of drugs: managing patients with invasive fungal disease
Providing integrated HIV treatment and care for stable patients in general practice
How can European countries improve cervical cancer prevention for women?
Exploring the value of a rapid, on-demand test for the detection of human papillomavirus
Estimating the true costs of splitting HIV antiretroviral drugs
There is a temptation to switch to cheaper generic antiretroviral drugs compared to fixed-dose combination therapy for HIV patients in the interests of cost savings. However, in our analysis we found that there were no costs saved when including all patient care including drugs, additional clinic visits and monitoring. We also found that switching may cause confusion for some patients, risking loss of adherence. This evidence can help commissioners make better policy decisions about drug provision.
Understanding Idiopathic Pulmonary Fibrosis patient care delivery and costs
We explored patient pathways for the diagnosis, management and monitoring of idiopathic pulmonary fibrosis (IPF) across England, based on NICE pathways, and interviews with healthcare staff from 14 hospital trusts. Data were used in our in-house tool to estimate the cost of pathways, compared to tariff reimbursement. We found large variation across England in how services for IPF patients are delivered, variation compared to the NICE pathway, and costs >40% more than what is currently reimbursed.
Increased efficiency and improved treatment for stable HIV patients in England
Collaborators at St Georges Hospital wanted to understand the impact of changing service provision for stable HIV patients, as no evidence existed on what was best for clinics. We built a tool in Excel, and results indicated that 6-monthly appointments and 3-monthly home delivery of drugs is the cheapest option and could yield £2000 savings per patient, translating to an annual cost reduction of ~£8 million for the estimated 4000 eligible patients not currently on home delivery in England in 2012.
The true cost of treating invasive fungal infections in hospitals
We first created a generic framework to help decision-makers think about how to compare patient management whilst considering all costs to the healthcare provider. Then, we developed a specific tool for management of patients with invasive fungal disease (IFD). Lastly, we estimated that the attributable cost of managing adult haematology patients with IFD at Kings College Hospital (London) was more than £50,000 per case, with the inpatient stay cost far outstripping the cost of antifungal drugs.