Exploring the value of a rapid, on-demand test for the detection of human papillomavirus

We explored the use of a rapid, on-demand human papillomavirus (HPV) test as part of a cervical screening programme. Through semi-structured interviews with experts from across the UK, we found that a co-located, laboratory-based, and on-demand HPV test following cytology could reduce the time to results by up to a week, whilst a near-patient test under primary HPV screening followed by cytology triage could radically change the testing paradigm, with most women notified the same day.

presentation_iconAdams EJ, Glover R, Vecino A, Postulka A. Exploring the value of a rapid, on-demand test for the detection of human papillomavirus. 30th International Papillomavirus Conference. Lisbon, Portugal. September 17 -21, 2015.

 

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Estimating the true costs of splitting HIV antiretroviral drugs

Problem: A regional UK commissioning decision in 2010 mandated that when the component drugs of Combivir—a combination therapy for HIV—come off patent, doctors must prescribe the individual drugs instead. This was driven by a perception that the generic component drugs are cheaper in the immediate-term and so more efficient overall. As our pharmaceutical client’s HIV combination drug was soon to come off patent, they wanted to help commissioners understand the full healthcare costs of such a policy, to inform future decisions.

Approach: We worked with our client and clinicians in Nottingham University Hospital’s HIV clinic who had patient-level care data before and after the commissioning change. We planned the analysis and identified which costs would be used and which data were required.

Impact: Our work contributes to the evidence-base of the costs of prescribing patients a single dose therapy over multiple doses. It has changed people’s perceptions of the costs of treating long-term conditions with combination drugs, and helped commissioners to make policy decisions about mandating use of particular drugs whilst taking a holistic view of healthcare.

 

Testimonial

“Aquarius provided a professional yet personal level of support with our project. We found the statistical support invaluable, and felt that they went the extra mile to ensure the project went smoothly and on time.”

  • Dr Ruth Taylor, Consultant in Genitourinary Medicine, Nottingham University Hospitals NHS Trust

 

Related publications

 publication_iconTaylor R, Carlin E, Sadique Z, Ahmed I, Adams EJ. The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study. Accepted Mar 2014, Int J STD AIDS

 

Increased efficiency and improved treatment for stable HIV patients in England

Problem: There was no guidance in England on how frequently stable HIV patients should attend clinics for routine visits, how frequently they should receive their HIV drugs and whether or not it would be cost efficient for patients to collect their drugs from the hospital pharmacy (which incurs VAT) or receive them through a home delivery (with associated delivery cost).

Approach: We built a simple spreadsheet tool in Microsoft Excel to estimate which strategy was the most cost-efficient. Local data from St George’s hospital were obtained and analysed, and supplemented with nationally published data as inputs in the model. Results suggested that the most cost efficient way of delivering care was to see stable patients for routine visits every six months in clinic, and give them their drugs through home delivery every three months; this would also save the most drug wastage for example if patients needed to switch to a new drug regimen. Results suggested that this could save roughly £2000 per patient annually, and roughly £8 million if it were implemented across England to the 4000 HIV patients in 2012.

Impact: Results were given to the London HIV commissioners, published in a peer-reviewed journal, and the tool is available to healthcare professionals so that they can put in their local data to help them make better decisions about healthcare provision.

 

Testimonial

“It has been a pleasure to work with Dr Elisabeth Adams on our costing project for HIV home delivery of drugs. I have also worked with her on research related to the POPI study of chlamydia screening.

She has a very professional and thorough approach to her work, and is good at delivering to timelines. I can recommend her as a partner for future work.”

  • Dr Phillip Hay, Reader and Honorary Consultant, Sexual Health and HIV Medicine, St. George’s Hospital, London

 

Related publications

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

Please contact us to request a version of the tool.

The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study

Switching to cheaper generic antiretroviral drugs for HIV patients may appear cost saving over fixed-dose combinations, and be an appealing way to reduce healthcare costs. However, the additional clinical costs may outweigh the initial cost savings of the drugs, and switching may cause confusion for some patients, risking loss of adherence. Our analysis provides evidence that can help commissioners make better policy decisions about drug provision.

publication_iconTaylor R, Carlin E, Sadique Z, Ahmed I, Adams EJ. The financial and service implications of splitting fixed-dose antiretroviral drugs – a case study. Int J STD AIDS 0956462414530588, first published on April 3, 2014 as doi:10.1177/0956462414530588

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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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The cost-effectiveness of point of care tests for chlamydia and gonorrhoeae in sexual health clinics

Replacing standard laboratory tests for chlamydia and gonorrhoea with a rapid point of care test could be cost-effective if implemented in genitourinary medicine clinics in England. It could save the National Health Service an estimated £10 million annually, and patients would benefit from fewer unnecessary treatments and reduced complications from infection, and it could prevent the number of transmissions.

publication_iconTurner KME, Round J, Horner PJ, et. al. What are the clinical and economic costs and benefits of implementing point of care NAAT tests for Chlamydia trachomatis and Neisseria gonorrhoeae in genitourinary medicine clinics in England? Sex Transm Infect. Published online 22 Nov 2013: doi:10.1136/sextrans-2013-051147

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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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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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